Direct Comparisons of Alfuzosin with Other
When compared with prazosin, IR alfuzosin had comparable efficacy and caused less cardiovascular adverse effects. Buzelin et al. compared the effects of alfuzosin with prazosin in 103 patients. IR alfuzosin 2.5 mg was administered three times a day. Prazosin was initiated in a step-up regimen of 1 mg daily on the first two days, 1 mg twice daily for the next five days, and then 2 mg twice daily beginning in the second week. Alfuzosin and prazosin produced similar increases in peak and mean urinary flow rates (26% and 28% and 30% and 27%, respectively) and in symptom score improvement (32% and 34%, respectively). However, alfuzosin caused less hypotensionrelated adverse effects than prazosin. Of the prazosin-treated patients, four experienced malaise, asthenia, and syncope. Only one patient receiving alfuzosin complained of dizziness; nausea and diplopia were reported in one and two patients, respectively.
When compared with tamsulosin, IR alfuzosin demonstrated comparable efficacy and caused a greater lowering of systolic and diastolic blood pressures. Buzelin et al. compared oral tamsulosin 0.4 mg once daily with oral alfuzosin 2.5 mg thrice daily for 12 weeks in 256 evaluable patients with BPH. Tamsulosin and alfuzosin were equally effective in increasing peak urinary flow rates (11.6 and 11.5 mL/sec, respectively) and improving Boyarsky scores (6.2 and 6.0, respectively). Tamsulosin caused fewer cardiovascular adverse effects. No significant change in blood pressure occurred in tamsulosin-treated patients, but a significant reduction in both standing and supine blood pressure (by 4-5 mm when compared to baseline) occurred in alfuzosin-treated patients (p < 0.05). The frequency of other adverse effects attributed to alfuzosin and tamsulosin (e.g., dizziness, headache, palpitation, tachycardia, postural hypotension, and syncope) was similar (10.5% and 9.2%, respectively). Both drugs also caused patients to have low but similar rates of erectile dysfunction.
Hofner et al. studied tamsulosin 0.4 mg daily, IR alfuzosin 2.5 mg thrice daily, and placebo in a sub-group of 830 patients with BPH. They found that abnormal ejaculation occurred more often in tamsulosintreated patients than those receiving placebo (p = 0.045). However, the frequency of this adverse effect was similar and low in tamsulosin- and alfuzosin-treated patients (less than 1% and 0, respectively). Because only three patients in the study discontinued the study drug because of this, the investigators regarded this adverse effect as minor.
Am J Health Syst Pharm. 2003;60(14) © 2003 American Society of Health-System Pharmacists
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