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Ingestional Toxicity of Radiation-Dependent Metabolites of the Host Plant for the Pale Grass Blue Butterfly: A Mechanism of Field Effects of Radioactive Pollution in Fukushima. Life (Basel) 2022; 12:life12050615. [PMID: 35629283 PMCID: PMC9146399 DOI: 10.3390/life12050615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/17/2022] Open
Abstract
Biological effects of the Fukushima nuclear accident have been reported in various organisms, including the pale grass blue butterfly Zizeeria maha and its host plant Oxalis corniculata. This plant upregulates various secondary metabolites in response to low-dose radiation exposure, which may contribute to the high mortality and abnormality rates of the butterfly in Fukushima. However, this field effect hypothesis has not been experimentally tested. Here, using an artificial diet for larvae, we examined the ingestional toxicity of three radiation-dependent plant metabolites annotated in a previous metabolomic study: lauric acid (a saturated fatty acid), alfuzosin (an adrenergic receptor antagonist), and ikarugamycin (an antibiotic likely from endophytic bacteria). Ingestion of lauric acid or alfuzosin caused a significant decrease in the pupation, eclosion (survival), and normality rates, indicating toxicity of these compounds. Lauric acid made the egg-larval days significantly longer, indicating larval growth retardation. In contrast, ikarugamycin caused a significant increase in the pupation and eclosion rates, probably due to the protection of the diet from fungi and bacteria. These results suggest that at least some of the radiation-dependent plant metabolites, such as lauric acid, contribute to the deleterious effects of radioactive pollution on the butterfly in Fukushima, providing experimental evidence for the field effect hypothesis.
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Recent Advances on Quinazoline Derivatives: A Potential Bioactive Scaffold in Medicinal Chemistry. CHEMENGINEERING 2021. [DOI: 10.3390/chemengineering5040073] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This paper intended to explore and discover recent therapeutic agents in the area of medicinal chemistry for the treatment of various diseases. Heterocyclic compounds represent an important group of biologically active compounds. In the last few years, heterocyclic compounds having quinazoline moiety have drawn immense attention owing to their significant biological activities. A diverse range of molecules having quinazoline moiety are reported to show a broad range of medicinal activities like antifungal, antiviral, antidiabetic, anticancer, anti-inflammatory, antibacterial, antioxidant and other activities. This study accelerates the designing process to generate a greater number of biologically active candidates.
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Sakauchi K, Taira W, Otaki JM. Metabolomic Response of the Creeping Wood Sorrel Oxalis corniculata to Low-Dose Radiation Exposure from Fukushima's Contaminated Soil. Life (Basel) 2021; 11:990. [PMID: 34575139 PMCID: PMC8472241 DOI: 10.3390/life11090990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
The biological consequences of the Fukushima nuclear accident have been intensively studied using the pale grass blue butterfly Zizeeria maha and its host plant, the creeping wood sorrel Oxalis corniculata. Here, we performed metabolomic analyses of Oxalis leaves from Okinawa to examine the plant metabolites that were upregulated or downregulated in response to low-dose radiation exposure from Fukushima's contaminated soil. The cumulative dose of radiation to the plants was 5.7 mGy (34 μGy/h for 7 days). The GC-MS analysis revealed a systematic tendency of downregulation among the metabolites, some of which were annotated as caproic acid, nonanoic acid, azelaic acid, and oleic acid. Others were annotated as fructose, glucose, and citric acid, involved in the carbohydrate metabolic pathways. Notably, the peak annotated as lauric acid was upregulated. In contrast, the LC-MS analysis detected many upregulated metabolites, some of which were annotated as either antioxidants or stress-related chemicals involved in defense pathways. Among them, only three metabolite peaks had a single annotation, one of which was alfuzosin, an antagonist of the α1-adrenergic receptor. We conclude that this Oxalis plant responded metabolically to low-dose radiation exposure from Fukushima's contaminated soil, which may mediate the ecological "field effects" of the developmental deterioration of butterflies in Fukushima.
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Affiliation(s)
- Ko Sakauchi
- The BCPH Unit of Molecular Physiology, Department of Chemistry, Biology and Marine Science, Faculty of Science, University of the Ryukyus, Okinawa 903-0213, Japan; (K.S.); (W.T.)
| | - Wataru Taira
- The BCPH Unit of Molecular Physiology, Department of Chemistry, Biology and Marine Science, Faculty of Science, University of the Ryukyus, Okinawa 903-0213, Japan; (K.S.); (W.T.)
- Center for Research Advancement and Collaboration, University of the Ryukyus, Okinawa 903-0213, Japan
| | - Joji M. Otaki
- The BCPH Unit of Molecular Physiology, Department of Chemistry, Biology and Marine Science, Faculty of Science, University of the Ryukyus, Okinawa 903-0213, Japan; (K.S.); (W.T.)
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Mari A, Antonelli A, Cindolo L, Fusco F, Minervini A, De Nunzio C. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol 2021; 13:1756287221993283. [PMID: 33912246 PMCID: PMC8047826 DOI: 10.1177/1756287221993283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/05/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are a bothersome frequent symptom in adult males. This systematic review analyzed the available evidence on the pharmacokinetic and pharmacodynamic features of alfuzosin, and its clinical efficacy both as monotherapy and in combination with other drugs for the treatment of male LUTS/BPH. METHODS A systematic review of the last 10 years was performed using the MEDLINE, EMBASE and Cochrane libraries in March 2020. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42020136120) and is available in full on the University of York website. RESULTS Alfuzosin is a quinazoline derivative and, although a nonspecific α1-blocker, exhibits a selective concentration in the prostate compared with plasma in patients with BPH. Three registration trials assessed the safety and efficacy of alfuzosin. The 10 mg daily formulation has a three-layered matrix containing the active substance between two inactive coats allowing a drug release over 20 h. Alfuzosin showed high tolerability, few vasodilatory effects and a low rate of ejaculation disorders over older alpha-blocking compounds thanks to the high uroselectivity of alfuzosin and its preferential concentration at urinary level. Six randomized clinical trials (RCTs) assessed efficacy and safety of alfuzosin versus other alpha-blockers ± placebo: three studies comparing with tamsulosin, one with doxazosin, and two with silodosin or tamsulosin. One RCT investigated the clinical outcomes of alfuzosin with finasteride, two with propiverine and two with phosphodiesterase-5 inhibitors. CONCLUSIONS Alfuzosin is an effective drug for the treatment of LUTS/BPH, with a lower rate of sexual disorders compared with other alpha-blockers. Alfuzosin is also safe with low adverse events in case of concomitant antihypertensive therapy and in patients with cardiovascular morbidity. Safety and efficacy of alfuzosin has been reported also in case of combination therapy with antimuscarinic agents and PDE5i.
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Affiliation(s)
- Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, San Luca Nuovo, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
- “Cure Group”, Hesperia Hospital, Modena, Italy
| | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo De Nunzio
- Division of Urology, Ospedale Sant’Andrea, Sapienza University of Rome, Rome, Italy
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Al Bawab AQ, Alkhalidi BA, Albarahmieh E, Qassim SMA, Al-Saifi MAD, Al-Saifi B, Ling J, Al-Qerem W. Pharmacokinetics and Bioequivalence Estimation of Two Formulations of Alfuzosin Extended-Release Tablets. Clin Pharmacol Drug Dev 2020; 9:780-784. [PMID: 32770667 DOI: 10.1002/cpdd.860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
Alfuzosin is a medication approved by the US Food and Drug Administration to treat benign prostatic hyperplasia symptoms. Bioequivalence studies are demanded by regulatory authorities to evaluate the expected in vivo biological similarity of 2 formulations of a medication. The aim of this study is to assess the bioavailability of the generic (test) and branded (reference) formulations of 10-mg alfuzosin extended-release tablets after oral administration to healthy adults under fed conditions. The study used a comparative randomized, single-dose, 2-way crossover open-label study design. Thirty-three participants were recruited and completed the clinical assessment. The pharmacokinetic parameters maximum plasma concentration (Cmax ), area under the plasma concentration-time curve (AUC0-t ), AUC extrapolated to infinity (AUC0-∞ ), time to maximum concentration, and elimination half-life were estimated to prove bioequivalence. The confidence intervals for the log-transformed test/reference ratios for alfuzosin 110.7% (98.0-124.9) and 112.0% (101.9-123.1) for Cmax and AUC0-t respectively, which are within the allowed limits specified by the regulatory authorities (80-125% for Cmax and AUC0-t ). The test formulation can therefore be prescribed as an alternative to the reference for symptomatic treatment of benign prostatic hyperplasia.
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Affiliation(s)
| | | | - Esra'a Albarahmieh
- School of Applied Medical Sciences, German Jordanian University, Amman, Jordan
| | | | | | | | | | - Walid Al-Qerem
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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Baezzat MR, Banavand F, Fasihi F. Electrooxidation study and highly sensitive voltammetric determination of alfuzosin employing multi-walled carbon nanotubes and the ionic liquid 1-hexylpyridinium hexafluorophosphate nanocomposite sensor. J Mol Liq 2017. [DOI: 10.1016/j.molliq.2017.02.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Žuvela P, Liu JJ, Plenis A, Bączek T. Assessment of column selection systems using Partial Least Squares. J Chromatogr A 2015; 1420:74-82. [PMID: 26456514 DOI: 10.1016/j.chroma.2015.09.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/26/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022]
Abstract
Column selection systems based on calculation of a scalar measure based on Euclidean distance between chromatographic columns, suffer from the same issue. For diverse values of their parameters, identical or near-identical values can be calculated. Proper use of chemometric methods can not only provide a remedy, but also reveal underlying correlation between them. In this work, parameters of a well-established column selection system (CSS) developed at Katholieke Universiteit Leuven (KUL CSS) have been directly correlated to parameters of selectivity (retention time, resolution, and peak/valley ratio) toward pharmaceuticals, by employing Partial Least Squares (PLS). Two case studies were evaluated, separation of alfuzosin, lamotrigine, and their impurities, respectively. Within them, comprehensive correlation structure was revealed, which was thoroughly interpreted, confirming a causal relationship between KUL parameters and parameters of column performance. Furthermore, it was shown that the developed methodology can be applied to any distance-based column selection system.
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Affiliation(s)
- Petar Žuvela
- Department of Chemical Engineering, Pukyong National University, 365 Sinseon-ro, 608-739 Busan, South Korea
| | - J Jay Liu
- Department of Chemical Engineering, Pukyong National University, 365 Sinseon-ro, 608-739 Busan, South Korea.
| | - Alina Plenis
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland
| | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland
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Zhu LL, Feng ZJ, Zhou Q. Personalized therapeutics of α₁-blockers in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Clin Interv Aging 2015; 10:621-2. [PMID: 25848238 PMCID: PMC4381895 DOI: 10.2147/cia.s82435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ling-ling Zhu
- Geriatric VIP Ward, Division of Nursing, Zhejiang University, Hangzhou, People’s Republic of China
| | - Zhi-jun Feng
- Department of Urology Surgery, Zhejiang University, Hangzhou, People’s Republic of China
| | - Quan Zhou
- Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
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The Diagnosis and Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia with α-Blockers: Focus on Silodosin. Clin Drug Investig 2015; 35 Suppl 1:7-18. [DOI: 10.1007/s40261-014-0257-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gao N, Wu H, Chang Y, Guo X, Zhang L, Du L, Fu Y. Mixed micelle cloud point-magnetic dispersive μ-solid phase extraction of doxazosin and alfuzosin. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2015; 134:10-16. [PMID: 24995413 DOI: 10.1016/j.saa.2014.06.095] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/03/2014] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
Mixed micelle cloud point extraction (MM-CPE) combined with magnetic dispersive μ-solid phase extraction (MD-μ-SPE) has been developed as a new approach for the extraction of doxazosin (DOX) and alfuzosin (ALF) prior to fluorescence analysis. The mixed micelle anionic surfactant sodium dodecyl sulfate and non-ionic polyoxyethylene(7.5)nonylphenylether was used as the extraction solvent in MM-CPE, and diatomite bonding Fe₃O₄ magnetic nanoparticles were used as the adsorbent in MD-μ-SPE. The method was based on MM-CPE of DOX and ALF in the surfactant-rich phase. Magnetic materials were used to retrieve the surfactant-rich phase, which easily separated from the aqueous phase under magnetic field. At optimum conditions, a linear relationship between DOX and ALF was obtained in the range of 5-300 ng mL(-1), and the limits of detection were 0.21 and 0.16 ng mL(-1), respectively. The proposed method was successfully applied for the determination of the drugs in pharmaceutical preparations, urine samples, and plasma samples.
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Affiliation(s)
- Nannan Gao
- Analytical and Testing Center, Shanxi Normal University, Linfen, Shanxi 041004, PR China
| | - Hao Wu
- Analytical and Testing Center, Shanxi Normal University, Linfen, Shanxi 041004, PR China.
| | - Yafen Chang
- Analytical and Testing Center, Shanxi Normal University, Linfen, Shanxi 041004, PR China
| | - Xiaozhen Guo
- Analytical and Testing Center, Shanxi Normal University, Linfen, Shanxi 041004, PR China
| | - Lizhen Zhang
- Analytical and Testing Center, Shanxi Normal University, Linfen, Shanxi 041004, PR China
| | - Liming Du
- Analytical and Testing Center, Shanxi Normal University, Linfen, Shanxi 041004, PR China.
| | - Yunlong Fu
- Analytical and Testing Center, Shanxi Normal University, Linfen, Shanxi 041004, PR China
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Chung JH, Lee JY, Kang DH, Jo JK, Lee JW, Lee SH, Lee KS, Kim TH, Han JH, Lee SW. Evaluation of patient outcome after discontinuation of alfuzosin treatment for benign prostatic hyperplasia: a multicentre, prospective study. Int J Clin Pract 2013; 67:870-5. [PMID: 23952466 DOI: 10.1111/ijcp.12108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/11/2012] [Indexed: 11/27/2022] Open
Abstract
AIMS The aim of this study was to assess patient outcome after discontinuation of alfuzosin treatment in patients with benign prostatic hyperplasia (BPH). METHODS This study included 200 BPH patients. Alpha-blockers were discontinued after 12 weeks of treatment when the International Prostatic Symptom Score (IPSS) was reduced to < 8 points, peak urine flow rate (Q(max)) was increased to ≥ 15 ml/s, the postvoiding residual (PVR) urine volume was ≤ 100 ml and the patient agreed to discontinue treatment. Urinary symptoms of the patients were assessed at 4, 8, 12 and 24 weeks after discontinuation of medication, and surveys were performed asking whether patients wanted to restart administration of medication. RESULTS Of 200 enrolled patients, 142 (71.00%) received 12 weeks of treatment with 10 mg of alfuzosin. The medication was discontinued in 58 of 142 patients (40.85%) because urinary symptoms had improved. Among these patients, follow-up observations were performed for 49 patients up to 24 weeks after treatment discontinued. Of these 49 patients, 28 (57.14%) showed correct urination without a need to restart treatment up to 24 weeks after the medication was discontinued. The discontinuation group demonstrated improved voiding symptoms, including Q(max) and PVR, relative to the re-administration group at baseline. Furthermore, the discontinuation group showed a smaller prostate volume than the re-administration group (p = 0.045). CONCLUSION When patients with BPH displayed symptomatic improvement upon treatment with alpha-blockers, the improvements were maintained in a select subpopulation of patients without the need to re-administer the alpha-blockers.
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Affiliation(s)
- J H Chung
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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Elzoghby AO, Samy WM, Elgindy NA. Novel Spray-Dried Genipin-Crosslinked Casein Nanoparticles for Prolonged Release of Alfuzosin Hydrochloride. Pharm Res 2012; 30:512-22. [DOI: 10.1007/s11095-012-0897-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 10/08/2012] [Indexed: 01/27/2023]
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Fahmy RH. Statistical approach for assessing the influence of calcium silicate and HPMC on the formulation of novel alfuzosin hydrochloride mucoadhesive-floating beads as gastroretentive drug delivery systems. AAPS PharmSciTech 2012; 13:990-1004. [PMID: 22806818 PMCID: PMC3429678 DOI: 10.1208/s12249-012-9823-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 06/18/2012] [Indexed: 11/30/2022] Open
Abstract
Multiparticulate floating drug delivery systems have proven potential as controlled-release gastroretentive drug delivery systems that avoid the "all or none" gastric emptying nature of single-unit floating dosage forms. An objective of the presence investigation was to develop calcium silicate (CaSi)/calcium alginate (Ca-Alg)/hydroxypropyl methylcellulose (HPMC) mucoadhesive-floating beads that provide time- and site-specific drug release of alfuzosin hydrochloride (Alf). Beads were prepared by simultaneous internal and external gelation method utilizing 3(2) factorial design as an experimental design; with two main factors evaluated for their influence on the prepared beads; the concentration of CaSi as floating aid (X (1)) and the percentage of HPMC as viscosity enhancer and mucoadhesive polymer (X (2)), each of them was tested in three levels. Developed formulations were evaluated for yield, entrapment efficiency, particle size, surface topography, and buoyancy. Differential scanning calorimetry, Fourier transform infrared spectroscopy, in vitro drug release, as well as in vitro mucoadhesion using rat stomach mucosal membrane were also conducted. Percentage yield and entrapment efficiency ranged from 57.03% to 78.51% and from 49.78% to 83.26%, respectively. Statistical analysis using ANOVA proved that increasing the concentration of either CaSi or HPMC significantly increased the beads yield. Both CaSi and HPMC concentrations were found to significantly affect Alf release from the beads. Additionally, higher CaSi concentration significantly increased the beads diameter while HPMC concentration showed significant positive effect on the beads mucoadhesive properties. CaSi/Ca-Alg/HPMC beads represent simple floating-mucoadhesive gastroretentive system that could be useful in chronopharmacotherapy of benign prostatic hyperplasia.
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Affiliation(s)
- Rania Hassan Fahmy
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., 11562, Cairo, Egypt.
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Cho KJ, Kim JC. Alfuzosin for the treatment of storage symptoms suggestive of overactive bladder. Expert Opin Pharmacother 2012; 13:1143-51. [DOI: 10.1517/14656566.2012.682149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Desiniotis A, Kyprianou N. Advances in the design and synthesis of prazosin derivatives over the last ten years. Expert Opin Ther Targets 2011; 15:1405-18. [PMID: 22148952 DOI: 10.1517/14728222.2011.641534] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Mechanistic, translational and pharmacological studies led to the identification and discovery of the preferred localization, binding characteristics, structure and functional properties of α1-adrenoceptor (α1-AR) subtypes in the bladder neck, bladder and prostate gland. The evidence gathered on α1-ARs, provided a molecular platform for the development of subtype-selective antagonists, resulting in more effective approaches targeting those receptors for the treatment of outlet bladder obstruction and benign prostate hyperplasia. AREAS COVERED Advances over the last decade in the design and optimization of Prazosin, Doxazosin and Terazosin quinazoline-based derivatives as α1-AR antagonists. Evidence on the metabolic and growth interference action by these agents, in addition to their smooth-muscle-relaxing effects. The new action recognition emerges from data on the inhibitory effect of quinazoline-based antagonists on primary tumor growth and progression to metastasis. In addition to the cellular findings in the prostate, functional validation and therapeutic effects of selected lead pharmaceutically optimized derivatives in the context of impairing vascularity and triggering tumor apoptosis. EXPERT OPINION Knowledge on targeting intracellular signalling pathways driving the cellular response via an α1-AR-dependent and independent antagonistic action, must be invested towards the optimization of new agents that while bypassing AR, exhibit improved pharmacological efficacy against human cancer.
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Affiliation(s)
- Andreas Desiniotis
- University of Kentucky Medical Center, University of Kentucky, College of Medicine, Department of Surgery, Combs Cancer Research Building, Room 306, Lexington, KY 40536, USA
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Randomized crossover comparison of tamsulosin and alfuzosin in patients with urinary disturbances caused by benign prostatic hyperplasia. Int Urol Nephrol 2011; 43:949-54. [DOI: 10.1007/s11255-011-9949-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 03/16/2011] [Indexed: 11/26/2022]
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Pattnaik S, Swain K, Bindhani A, Mallick S. Influence of chemical permeation enhancers on transdermal permeation of alfuzosin: an investigation using response surface modeling. Drug Dev Ind Pharm 2011; 37:465-74. [DOI: 10.3109/03639045.2010.522192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pattnaik S, Kalpana S, Choudhury P, Acharya PK, Mallick S. Alfuzosin hydrochloride transdermal films: evaluation of physicochemical, in vitro human cadaver skin permeation and thermodynamic parameters. Int Braz J Urol 2009; 35:716-29. [DOI: 10.1590/s1677-55382009000600010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2009] [Indexed: 11/21/2022] Open
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Subtypes of alpha1-adrenoceptors in BPH: future prospects for personalized medicine. ACTA ACUST UNITED AC 2009; 6:44-53. [PMID: 19132005 DOI: 10.1038/ncpuro1276] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 11/14/2008] [Indexed: 12/18/2022]
Abstract
The alpha(1)-adrenoceptors (alpha(1)-ARs) are involved in regulation of prostatic smooth muscle tone, and are a critical mediator of lower urinary tract symptoms and pathophysiology in benign prostatic hyperplasia (BPH). As a result, alpha(1)-AR antagonists are now used as first-line medical treatment for BPH. Three alpha(1)-AR subtypes (alpha(1a)-AR, alpha(1b)-AR, alpha(1d)-AR) have been identified on the basis of results of pharmacological and molecular cloning studies; however, the precise physiological role of individual alpha(1)-AR subtypes remains elusive. The expression levels of alpha(1)-AR subtypes in the prostate differ between patients, and individual differences in the genetic background of patients with BPH might be associated with variation in responses to subtype-selective alpha(1)-AR antagonists. In addition, single nucleotide polymorphism and microarray-based gene expression profiling studies might provide an opportunity to identify markers that predict clinical response and therapeutic tolerance to alpha(1)-AR antagonists. Further genomic studies will refine our knowledge of the functions of alpha(1)-AR subtypes, lead to new strategies for the clinical management of BPH and, perhaps, enable personalized treatment of BPH in the future.
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Roehrborn CG, Rosen RC. Medical therapy options for aging men with benign prostatic hyperplasia: focus on alfuzosin 10 mg once daily. Clin Interv Aging 2008; 3:511-24. [PMID: 18982921 PMCID: PMC2682383 DOI: 10.2147/cia.s3635] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are common in aging men and can significantly affect quality of life. Men with bothersome LUTS/BPH often present with various other age-related conditions, including sexual dysfunction, heart disease, hypertension, diabetes, and the metabolic syndrome, which can complicate management decisions. Therefore, healthcare providers should be familiar with first-line treatment options for LUTS/BPH and their differing safety profiles, particularly with respect to cardiovascular and sexual function side effects. This article presents a review of first-line medical therapy options for managing aging men with LUTS/BPH and patient considerations when evaluating and selecting these therapies, with a focus on the clinical efficacy and cardiovascular and sexual function safety profiles of the uroselective alpha1-adrenergic receptor antagonist alfuzosin 10 mg once daily. Alfuzosin improves LUTS, peak urinary flow rates, and disease-specific quality of life, reduces the long-term risk of overall BPH progression, and is well tolerated in aging men, with minimal vasodilatory and sexual function side effects, even in those with comorbidities. Alfuzosin is well tolerated when used in combination with antihypertensive medications and phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction. The long-term clinical efficacy and good cardiovascular and sexual function safety profile of alfuzosin can contribute to an improved quality of life for aging men with LUTS/BPH.
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Affiliation(s)
- Claus G Roehrborn
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
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Highly sensitive and rapid LC–ESI-MS/MS method for the simultaneous quantification of uroselective α1-blocker, alfuzosin and an antimuscarinic agent, solifenacin in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2008; 876:236-44. [DOI: 10.1016/j.jchromb.2008.10.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 10/25/2008] [Accepted: 10/29/2008] [Indexed: 11/24/2022]
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Kim SY, Kim BH, Dong SH, Kim HJ, Chang YW, Chang R, Kim YW. Alfuzosin-induced acute liver injury. THE KOREAN JOURNAL OF HEPATOLOGY 2008; 13:414-8. [PMID: 17898558 DOI: 10.3350/kjhep.2007.13.3.414] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We describe a 56-year-old man who developed an acute liver injury after taking alfuzosin for 1 month to control his newly diagnosed benign prostatic hypertrophy (BPH). There was no history of alcohol consumption or the taking herbal or traditional remedies. Viral causes, autoimmune hepatitis, and biliary tree obstruction were excluded. Other rare causes of hepatitis such as hemochromatosis, primary biliary cirrhosis and Wilson's disease were also absent in this patient. His liver test results began to improve after discontinuing the alfuzosin. Two weeks later, alfuzosin was administered again because the patient complained of dysuria. After 10 days of alfuzosin reuse, his liver test results worsened. Five months later after the complete discontinuation of the drug, his liver test results had returned to normal. This clinical sequence suggests that alfuzosin caused his acute liver injury.
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Affiliation(s)
- Seok Yeon Kim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Resnick MI, Roehrborn CG. Rapid onset of action with alfuzosin 10 mg once daily in men with benign prostatic hyperplasia: a randomized, placebo-controlled trial. Prostate Cancer Prostatic Dis 2007; 10:155-9. [PMID: 17211442 DOI: 10.1038/sj.pcan.4500925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This randomized, double-blind, placebo-controlled study was conducted to investigate whether alfuzosin 10 mg once daily improves the maximum flow rate (Q(max)) and lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) after 1 week and 1 month of treatment. A total of 372 men aged > or = 50 years with symptomatic BPH received alfuzosin or placebo for 28 days. Q(max) increased significantly from baseline at day 8 with alfuzosin (P<0.001 versus placebo); this improvement was evident within 24 h after the first dose and was maintained at day 29. LUTS improved from baseline with alfuzosin at day 8 (P=0.07 versus placebo) and day 29 (P=0.003 versus placebo). Alfuzosin 10 mg once daily exhibits a rapid onset of action, with improvements in Q(max) and LUTS maintained through 1 month of treatment.
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Affiliation(s)
- M I Resnick
- Department of Urology, Case Medical Center, Cleveland, OH 44106, USA.
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Salah Fayed A, Abdel-Aaty Shehata M, Yehia Hassan N, El-Weshahy SA. Validated HPLC and HPTLC stability-indicating methods for determination of alfuzosin hydrochloride in bulk powder and pharmaceutical formulations. J Sep Sci 2006; 29:2716-24. [PMID: 17305232 DOI: 10.1002/jssc.200600220] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two sensitive, selective, and precise stability-indicating, high-performance liquid chromatography and high-performance thin-layer chromatography methods have been developed for the determination of alfuzosin hydrochloride in the presence of its degradation products. Alfuzosin.HCl was subjected to stress alkaline, acidic, oxidative, thermal, and photo-degradation. The drug could be well separated from the degradation products upon applying the two methods. Separation by HPLC was achieved using an Xterra RP18 column and acetonitrile/0.02 M KH2PO4 (pH=3) in a ratio of 20:80 as mobile phase. The flow rate was 1 mL/min. The linearity range was 0.25 to 11 microg/mL with mean percentage recovery of 100.26 +/- 1.54. The HPTLC method used ALUGRAM Nano-SIL silica gel 60 F254 plates; the optimized mobile phase was methanol/ammonia (100:1.2). Quantitatively the spots were scanned densitometrically at 245 nm. A second order polynomial equation was used for the regression. The range was 0.5-7 microg/spot. The mean percentage recovery was 100.13 +/- 1.67. Two main degradation products were obtained in most stress conditions, separated, and identified by FT-IR and NMR spectral analysis, from which the degradation pathway was proposed. The two methods were validated according to the International Conference on Harmonization. In addition, the HPLC method was used to study the kinetics of alkaline and acid degradation of the drug.
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Affiliation(s)
- Ahmed Salah Fayed
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Cairo, Egypt.
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Elhilali MM. Alfuzosin: an alpha1-receptor blocker for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. Expert Opin Pharmacother 2006; 7:583-96. [PMID: 16553574 DOI: 10.1517/14656566.7.5.583] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Alpha1-receptor blockers have become first-line therapy for the medical management of lower urinary tract symptoms associated with benign prostatic hyperplasia. However, adverse effects such as cardiovascular intolerance can limit their use. This article focuses on alfuzosin, a clinically uroselective, alpha1-adrenergic antagonist that is available as a novel once-daily formulation that does not require dose titration. Alfuzosin is less vasoactive than other non-subtype selective alpha1-receptor blockers. In addition to effects on lower urinary tract symptoms, it is also used as an adjunct to urethral catheterisation in patients with acute urinary retention related to benign prostatic hyperplasia, and can improve sexual function and health-related quality of life in benign prostatic hyperplasia sufferers.
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Alfuzosin (10 mg) does not affect blood pressure in young healthy men. Eur Urol 2006; 50:1292-6; discussion 1297-8. [PMID: 16837126 DOI: 10.1016/j.eururo.2006.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 06/12/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Alfuzosin 10mg is a uroselective alpha(1)-adrenoceptor antagonist used to treat lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Recent studies have suggested the potential efficacy of alfuzosin in the treatment of distal ureteral stones and prostatitis syndrome, two conditions frequently encountered in young patients. The objective of this study was to evaluate the effect of 10mg alfuzosin on blood pressure (BP) and heart rate (HR) in young healthy volunteers. MATERIALS AND METHODS In a randomized, double-blind, placebo-controlled, crossover study, the effect of alfuzosin 10mg on BP and HR was evaluated in 14 male volunteers (mean age: 28 yr; range: 24-30). BP<135/85 obtained in two separated measurements was a main inclusion criterion. Patients were then randomized to alfuzosin (10mg once a day) or placebo for 1 wk, followed by a washout week, and then crossed over to the other treatment. Patients were instructed to self-measure systolic (SBP) and diastolic (DBP) blood pressure and HR every hour between 8am and 8pm during the first and the last day of each cycle treatment. RESULTS All 14 enrolled volunteers completed the study. No significant difference in either SBP, DBP, or HR was observed between the placebo and alfuzosin groups at baseline. Alfuzosin did not affect SBP, DBP, or HR. No hypotensive episode (SBP reduction >10%) was recorded during each treatment. CONCLUSIONS This study shows that alfuzosin 10mg is well tolerated by young healthy subjects and may therefore be safely administered to young normotensive patients affected by distal ureteral stones and prostatitis.
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Roehrborn CG. Three months' treatment with the alpha1-blocker alfuzosin does not affect total or transition zone volume of the prostate. Prostate Cancer Prostatic Dis 2006; 9:121-5. [PMID: 16304557 DOI: 10.1038/sj.pcan.4500849] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment with alpha(1)-adrenergic receptor blockers improves lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. This study was conducted to test the hypothesis that induction of apoptosis in prostate tissue could be a mechanism underlying the observed clinical benefit. This placebo-controlled, double-blind, randomized trial enrolled 536 men with LUTS who were treated with alfuzosin (10 or 15 mg) once daily or placebo for 3 months. Total prostate and transition zone volume was measured by standardized transrectal ultrasound measurements at baseline and 3 months. Total prostate volume increased by 0.4 ml from baseline in placebo patients but decreased by -0.25 ml in the combined alfuzosin groups. Percentage change was not statistically significantly different between the placebo and alfuzosin groups. Changes in transition zone volumes from baseline were similar in both treatment arms; percentage change was not statistically significantly different between the placebo and alfuzosin groups. Volume changes did not correlate with prostate volumes at baseline. Overall, neither total prostate nor transition zone volume increased or decreased systematically within the 3-month treatment period. If alfuzosin-induced apoptosis in prostate tissue, it was not evident by a measurable change in prostate volume after 3 months' treatment. Further analysis at 1 and 2 years will determine the effect of longer-term treatment.
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Affiliation(s)
- C G Roehrborn
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, 75392-9110, USA.
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Michel MC, Chapple CR. Comparison of the Cardiovascular Effects of Tamsulosin Oral Controlled Absorption System (OCAS®) and Alfuzosin Prolonged Release (XL). Eur Urol 2006; 49:501-8; discussion 508-9. [PMID: 16442211 DOI: 10.1016/j.eururo.2005.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 12/05/2005] [Accepted: 12/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The cardiovascular (CV) effects of tamsulosin oral controlled absorption system (OCAS) 0.4 mg were compared with those of alfuzosin prolonged release (XL) 10 mg. METHODS Two single-dose, crossover studies were performed. In study 1, CV alpha1-adrenoceptor antagonism was assessed by measuring the inhibition of phenylephrine (PE)-induced increases in diastolic blood pressure (DBP) and total peripheral resistance (TPR) before and after dosing with placebo, tamsulosin OCAS, and alfuzosin XL in 18 young subjects. In study 2, orthostatic stress tests (OTs) were performed before and after dosing with tamsulosin OCAS and alfuzosin XL in 40 elderly subjects. Pharmacokinetics were assessed in both studies. RESULTS In study 1, tamsulosin OCAS induced statistically significantly less inhibition of PE-induced increases in DBP at 2 h after dosing and in TPR at 2 and 4 h after dosing than alfuzosin XL. In study 2, tamsulosin OCAS had a lower incidence of positive OTs than did alfuzosin XL, with the difference between both treatments being statistically significant at 6h after dosing and for all time points after dosing combined. This was in line with smaller changes in vital signs observed for tamsulosin OCAS. The t(max) values for both treatments were comparable. CONCLUSIONS Tamsulosin OCAS 0.4 mg produces smaller vascular effects than does alfuzosin XL 10 mg.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology & Pharmacotherapy, University of Amsterdam, AMC, Amsterdam, The Netherlands.
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Kaplan SA, Neutel J. Vasodilatory factors in treatment of older men with symptomatic benign prostatic hyperplasia. Urology 2006; 67:225-31. [PMID: 16442606 DOI: 10.1016/j.urology.2005.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 08/17/2005] [Accepted: 09/15/2005] [Indexed: 11/23/2022]
Affiliation(s)
- Steven A Kaplan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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Alfuzosin for Symptomatic Benign Prostatic Hyperplasia. J Urol 2006. [DOI: 10.1097/00005392-200601000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McVary KT. Alfuzosin for Symptomatic Benign Prostatic Hyperplasia: Long-Term Experience. J Urol 2006; 175:35-42. [PMID: 16406865 DOI: 10.1016/s0022-5347(05)00032-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 01/26/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE Evidence of the long-term efficacy and safety of alfuzosin treatment for LUTS indicative of BPH was examined. MATERIALS AND METHODS An English literature search of MEDLINE, PubMed and proceedings from scientific meetings from 1974 to 2004 was done. Search terms included benign prostatic hyperplasia, alfuzosin, treatment, alpha(1)-adrenergic receptor blocker, long-term, followup, lower urinary tract symptoms, complications or adverse events, sexual, retention and cardiovascular. RESULTS Currently alpha(1)-adrenergic receptor blocking agents are first line treatment for BPH. Although all alpha-blocking compounds show similar levels of efficacy for LUTS treatment, newer agents such as alfuzosin tend to demonstrate improved selectivity for the prostate and bladder with few vasodilatory effects and they have tolerability advantages over older alpha-blocking compounds. Immediate, sustained and newer extended release alfuzosin formulations significantly improve LUTS indicative of BPH but extended release alfuzosin may be more convenient to administer and it tends to show better vasodilatory tolerability than the older immediate release formulation. CONCLUSIONS When used to treat BPH, alfuzosin provides symptom relief, decreased residual post-void urine volume and a decreased risk of acute urinary retention, which are maintained during long-term use. Most vasodilatory side effects occur early in treatment and they become less frequent thereafter. Patient quality of life also improves with maximal improvements observed after 12 months of treatment. Continued study will further clarify the physiological, clinical and personal benefits produced by alfuzosin when used for the management of LUTS indicative of BPH.
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Affiliation(s)
- Kevin T McVary
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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MacDonald R, Wilt TJ. Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects. Urology 2005; 66:780-8. [PMID: 16230138 DOI: 10.1016/j.urology.2005.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 05/04/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy and adverse effects of alfuzosin for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). METHODS The included studies were randomized controlled trials involving men with symptomatic BPH treated with alfuzosin versus placebo or active control for at least 4 weeks. RESULTS The search strategy identified 11 trials involving 3901 men with a mean age of 64 years. Eight trials were placebo-controlled studies, two were alfuzosin versus alternative alpha-blockers, and one was alfuzosin versus finasteride and combination alfuzosin/finasteride therapy. The study durations were short term, 4 to 26 weeks. The mean baseline symptom scores and peak urinary flow rates were indicative of moderate BPH. Alfuzosin (7.5 or 10 mg) improved lower urinary tract symptoms assessed by the International Prostate Symptom Score compared with placebo. The mean absolute change from baseline was -5.4 points for alfuzosin compared with -3.6 points for placebo, a weighted mean difference of 1.8 points (three studies). Alfuzosin increased the peak urinary flow more than did placebo, although the improvement varied across the eight studies. Symptom and flow improvements were generally comparable to that with combination therapy and with other alpha1-blockers. Alfuzosin had good short-term tolerability, and the numbers of study withdrawals were comparable to those with placebo and controls. Efficacy and short-term safety were similar across the various (immediate-release, sustained, and once-daily) formulations. CONCLUSIONS The results from short-term studies have indicated that alfuzosin improves lower urinary tract symptoms and urinary flow more than does placebo and is generally well tolerated in men with symptomatic BPH. Long-term efficacy and safety studies in combination with a 5-alpha-reductase inhibitor should be initiated.
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Affiliation(s)
- Roderick MacDonald
- Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA.
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Abstract
In the first of these mini-reviews the selection of therapy for the maintenance of sexual function in patients with BPH is outlined, along with an explanation of how altered regulation of neurotransmitters, especially noradrenaline, may underlie the syndrome of LUTS and sexual dysfunction. Other mini-reviews outline the current status of robotic surgery to treat renal and adrenal disorders, and its future applications, and the potential use of the nitric oxide/cGMP pathway as a potential target to treat BOO associated with benign prostatic enlargement. Finally, the capacity to be creative in academic departments is extolled as a core property of academicians, and its surfacing described as having the potential to revitalize individuals and departments.
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Affiliation(s)
- Ajay Nehra
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
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Rosen RC, Giuliano F, Carson CC. Sexual Dysfunction and Lower Urinary Tract Symptoms (LUTS) Associated with Benign Prostatic Hyperplasia (BPH). Eur Urol 2005; 47:824-37. [PMID: 15925080 DOI: 10.1016/j.eururo.2004.12.013] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 12/17/2004] [Indexed: 01/23/2023]
Abstract
Sexuality is an essential aspect of a couple's relationship and has a significant impact on life satisfaction. Benign prostatic hyperplasia (BPH) is a condition that commonly affects older men and is often associated with lower urinary tract symptoms (LUTS) and sexual dysfunction. Men with moderate-to-severe LUTS are at increased risk for sexual dysfunction, including moderate-to-severe erectile dysfunction (ED), ejaculatory dysfunction (EjD), and hypoactive desire (HD). The results of several recent large-scale studies have shown a consistent and strong relationship between LUTS and both ED and EjD. It appears that the pathophysiological mechanisms of LUTS and the related prostatic enlargement of BPH as well as certain treatments for this condition may have an impact on both the erection and ejaculation components of the sexual response. Validated questionnaires that assess sexual function provide clinicians with valuable information to help guide treatment selection decisions. Effective medical therapies for LUTS associated with BPH include alpha(1)-adrenergic receptor antagonists (i.e., alfuzosin, doxazosin, tamsulosin, and terazosin) and 5alpha-reductase inhibitors (i.e., finasteride and dutasteride). The side effects of these medications, including sexual dysfunction, are important distinguishing features. The successful management of patients with LUTS associated with BPH should include assessments of sexual function and monitoring of medication-related sexual side effects. For men with LUTS and sexual dysfunction, an appropriate integrated management approach, based on each patient's symptoms and outcome objectives, is warranted.
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Affiliation(s)
- Raymond C Rosen
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 675 Hoes Lane, Piscataway, NJ 08854, USA.
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Martin DJ, Mulhall JP. Enlarging the scope of managing benign prostatic hyperplasia: addressing sexual function and quality of life. Int J Clin Pract 2005; 59:579-90. [PMID: 15857355 DOI: 10.1111/j.1368-5031.2005.00531.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Benign prostatic hyperplasia is a common genitourinary disorder that increases in incidence with age. Symptoms of this condition include a weak urinary stream, hesitancy, intermittency and sensations of incomplete emptying, as well as frequency, urgency, urge incontinence and nocturia. These symptoms can be ameliorated successfully by a variety of medical treatments - such as alpha(1)-adrenergic blockade and 5-alpha-reductase inhibition - and surgical therapies - including transurethral resection of the prostate and less-invasive procedures. However, many of the treatments are known to result in sexual dysfunction, which can have a negative impact on the patient's quality of life. This must be considered when the physician seeks to determine the appropriate treatment for an individual patient. Current reports suggest that alpha(1)-adrenergic blockade is most likely to improve lower urinary tract symptoms while resulting in the fewest sexual side-effects; 5-alpha-reductase inhibitors appear to be particularly appropriate in men with large prostates. Among surgical therapies, transurethral resection of the prostate remains the gold standard, but is associated with a high incidence of sexual side-effects, especially retrograde ejaculation. Transurethral incision of the prostate, which is an endoscopic procedure, may be as effective as transurethral resection, but results in fewer side-effects. Minimally invasive procedures, including laser ablation or resection of the prostate, transurethral microwave thermotherapy and transurethral needle ablation, are rapidly evolving technologies that have demonstrated promising results, at least in the short term.
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Affiliation(s)
- D J Martin
- Department of Urology, Loyola University Medical Center, Stritch school of Medicine, Maywood, IL, USA
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Nordling J. Efficacy and safety of two doses (10 and 15 mg) of alfuzosin or tamsulosin (0.4 mg) once daily for treating symptomatic benign prostatic hyperplasia. BJU Int 2005; 95:1006-12. [PMID: 15839922 DOI: 10.1111/j.1464-410x.2005.05456.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of two doses (10 and 15 mg) of alfuzosin once daily and tamsulosin (0.4 mg) once daily, compared with placebo, in men with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS In this randomized, double-blind, placebo-controlled, multicentre study, 625 patients were randomized to receive alfuzosin 10 or 15 mg once daily, tamsulosin 0.4 mg once daily (active reference), or matching placebo for 12 weeks, with no initial dose titration. The study was designed to compare each of the three active treatments with the placebo group. Primary outcome measures were mean changes from baseline in the International Prostate Symptom Score (IPSS) and peak urinary flow rate (Qmax) at 12 weeks, compared with placebo, using one-way analysis of variance. Because Qmax data were not normally distributed, median changes from baseline were also compared for Qmax. Pair-wise comparisons were conducted using the Dunnett correction for quantitative variables and Bonferroni-Holm correction for categorical variables, allowing for multiple treatment group comparisons. RESULTS Alfuzosin 10 mg significantly improved urinary tract symptoms compared with placebo, with a mean (sd) change from baseline in the IPSS of -6.5 (5.2) vs -4.6 (5.8) for placebo (adjusted P = 0.007); there was a trend toward a difference between alfuzosin 15 mg, with a mean (sd) change from baseline in IPSS of -6.0 (5.6), and placebo (adjusted P = 0.050). The mean change from baseline in IPSS with tamsulosin 0.4 mg, at -6.5 (5.6), vs placebo was also significant (adjusted P = 0.014). The median change from baseline in Qmax was significantly increased with both alfuzosin doses and with tamsulosin (all adjusted P = 0.02 vs placebo). Both doses of alfuzosin were well tolerated, with dizziness the most frequent adverse event (placebo, 4%; alfuzosin 10 mg, 6%; 15 mg, 7%; tamsulosin, 2%); the respective incidence rates of sexual function adverse events were 0%, 3%, 1% and 8%. CONCLUSION Treatment with alfuzosin 10 mg significantly improved urinary symptoms and Qmax compared with placebo and was well tolerated. There were also significant improvements over placebo with the active reference, tamsulosin 0.4 mg. The incidence of sexual function adverse events was higher with tamsulosin than with placebo. The benefit-to-risk profile of alfuzosin 10 mg once daily appeared to be reduced with a higher dose (15 mg).
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Affiliation(s)
- Jørgen Nordling
- Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
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Di Tonno F, Mazzariol C, Piazza N, Omacini S, Malossini G, Contemori G. Effects on Sexual Function by the Drugs used in the Treatment of Benign Prostatic Hyperplasia and Prostate Cancer. A Practical Guide for the Urologist. Urologia 2005. [DOI: 10.1177/039156030507200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects on sexual function (SF) by the drugs commonly used in the treatment of benign prostatic hyperplasia (BPH) and prostate cancer (PC) have been analyzed. BPH therapy: alpha-blockers have no adverse effects on SF; the only one without significant hypotensive effect, Tamsulosin, can cause retrograde ejaculation in 4–8% of cases. 5-Alpha-reductase (Finasteride and Dutasteride) inhibitors could have detrimental effects on erectile function, libido and ejaculation in a small percentage of cases rarely exceeding 10%; these effects are reversible and their incidence reduces after 1 yr. Phytotherapy (extracts from pygeum africanum and serenoa repens) and mepartricin have no unfavorable action on SF. PC therapy: Loss of erectile function and libido are the norm with the use of LH-RH analogues, estrogens and steroidal antiandrogens (cyproterone acetate). Non-steroidal antiandrogens (Flutamide, Bicalutamide and Nilutamide) allow the preservation of SF in two-thirds of cases.
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Affiliation(s)
- F. Di Tonno
- Unità Operativa di Urologia, Azienda ULSS 12 “Veneziana”, Presidio Ospedaliero di Venezia
| | - C. Mazzariol
- Unità Operativa di Urologia, Azienda ULSS 12 “Veneziana”, Presidio Ospedaliero di Venezia
| | - N. Piazza
- Unità Operativa di Urologia, Azienda ULSS 12 “Veneziana”, Presidio Ospedaliero di Venezia
| | - S. Omacini
- Unità Operativa di Urologia, Azienda ULSS 12 “Veneziana”, Presidio Ospedaliero di Venezia
| | - G. Malossini
- Unità Operativa di Urologia, Azienda ULSS 12 “Veneziana”, Presidio Ospedaliero di Venezia
| | - G. Contemori
- Unità Operativa di Urologia, Azienda ULSS 12 “Veneziana”, Presidio Ospedaliero di Venezia
- Unità Semplice di Andrologia, Azienda ULSS 12 “Veneziana”, Presidio Ospedaliero di Venezia
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Abstract
Alfuzosin (UroXatral, Sanofi-Synthelabo) a quinazoline derivative, has well-documented alpha(1)-adrenoreceptor antagonist activity. These receptors are present in the smooth muscle located at the bladder base, proximal urethra, prostate and prostatic capsule as well as in vascular and nervous systems. Consequently, alfuzosin has the ability to reduce the tone of these areas, effectively decreasing bladder outlet resistance. A sustained-release formulation of alfuzosin is currently available in Europe and is FDA-approved in the US. The confirmed efficacy, proven bioavailability and good cardiovascular safety profile support the use of this drug for the management of lower urinary tract symptoms secondary to benign prostate hyperplasia (BPH). These findings have been confirmed in a large cohort of patients treated in general practice. Additionally, treatment with alfuzosin has demonstrated a favourable impact on quality of life of patients with BPH.
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Affiliation(s)
- David M Weiner
- Urology, Columbia University College of Physicians and Surgeons, 425 West 59th Street Suite 3A, New York, NY 10019, USA.
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Michel MC, Korstanje C, Krauwinkel W, Kuipers M. The Pharmacokinetic Profile of Tamsulosin Oral Controlled Absorption System (OCAS®). ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.eursup.2004.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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De Nunzio C, Franco G, Leonardo C, Trucchi A, Tubaro A, Laurenti C. Effect of Once-Daily Alfuzosin on Urinary Symptoms and Flow Rate in??Benign Prostatic Hyperplasia. Clin Drug Investig 2005; 25:359-65. [PMID: 17532676 DOI: 10.2165/00044011-200525060-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To analyse the clinical and 24-hour urinary flow efficacy of alfuzosin 10mg once daily (OD), by means of the International Prostate Symptom Score (I-PSS) and home-based uroflowmetry (P-Flow) measurement, in patients with lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. MATERIALS AND METHODS In this open-label trial, 12 male patients (median age 67 years) with an I-PSS >15 (median 16) and maximum urinary flow (Q(max)) <15 mL/sec were evaluated. Patients underwent two days of P-Flow evaluation, and then received alfuzosin 10mg OD from day 3 to day 9. On days 7 and 8 they underwent further P-Flow evaluation. A second post-baseline evaluation I-PSS was recorded on day 9. RESULTS Overall, 328 urinary flows were recorded and evaluated, an average of 27 flows per patient. A statistically significant improvement in mean maximum flow: (Q(max)) [10.8 +/- 2.8 vs 12.4 +/- 3 mL/sec; p = 0.02] and urinary voiding volume (219 +/- 70 vs 233 +/- 55mL; p = 0.04) were observed after treatment compared with baseline. No differences in the number of urinary flows were observed between baseline and after treatment (13 +/- 2.9 vs 14 +/- 1.8 flows; p = 0.199). A statistically significant difference between the two evaluations was noted for I-PSS (15.7 +/- 0.8 and 9.5 +/- 2; p = 0.02). Mean Q(max) recorded during treatment was always higher than baseline at different daytime evaluations. CONCLUSION The alfuzosin 10mg OD formulation showed a significant improvement in I-PSS as well as a significant improvement in urinary flow parameters (Q(max)and urinary voiding volume) lasting for 24 hours in patients with LUTS.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, ‘La Sapienza’, University of Rome, Rome, Italy
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Lowe FC. Role of the newer alpha, -adrenergic-receptor antagonistsin the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms. Clin Ther 2004; 26:1701-13. [PMID: 15639685 DOI: 10.1016/j.clinthera.2004.11.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although initially introduced for the management of hypertension, alpha(1)-adrenergic-receptor antagonists (alpha1-blockers) have become the standard of care for the medical management of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). However, these agents have the potential to produce orthostatic hypotension and other blood pressure-related adverse effects in normotensive patients and in those receiving concurrent treatment with other antihypertensive agents. As a result, more "uroselective," less vasoactive alpha(1)-blockers have been developed. OBJECTIVE This article reviews current information on the role of alpha(1)-blockers in the treatment of BPH-related LUTS. The focus is on tamsulosin and alfuzosin, newer "uroselective" agents in this class that have a decreased potential for cardiovascular adverse effects. METHODS Relevant articles were identified through a search of the English-language literature indexed on MEDLINE and the proceedings of scientific meetings from 1976 to 2003. The search terms were benign prostatic hyperplasia treatment, alpha(1)-adrenergic-receptor blocker, uroselectivity, lower urinary tract symptoms, complications, and cardiovascular. RESULTS Tamsulosin has selectivity for the a alpha(1) and alpha(1d) receptor subtypes. Alfuzosin, although not receptor subtype selective, is clinically "uroselective" and does not significantly affect vascular alpha-adrenergic receptors. Both agents are efficacious in relieving LUTS and have a decreased potential for such cardiovascular adverse effects as postural hypotension. Common adverse events with these agents include dizziness and asthenia. CONCLUSION Based on the available data, "uroselective" alpha(1)-blockers should be considered over older, more vasoactive agents for the medical management of LUTS, particularly in patients with BPH and hypertension.
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Affiliation(s)
- Franklin C Lowe
- Department of Urology, Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, 425 West 59th Street, Suite 3A, New York, NY 10019, USA.
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Tambaro S, Ruiu S, Dessi C, Mongeau R, Marchese G, Pani L. Evaluation of tamsulosin and alfuzosin activity in the rat vas deferens: relevance to ejaculation delays. J Pharmacol Exp Ther 2004; 312:710-7. [PMID: 15470085 DOI: 10.1124/jpet.104.074740] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The effect of two alpha-adrenergic receptor antagonists widely employed in the therapy of benign prostatic hyperplasia, tamsulosin [(-)-(R)-5-[2-[[2-(0-ethoxyphenoxy) ethyl]amino]propyl]-2-methoxybenzenesulfonamide] and alfuzosin [(+/-)-N-[3-[(4-amino-6,7-dimethoxy-2-quinazolinyl) methylamino]propyl] tetrahydro-2-furancarboxamide], was investigated in the rat vas deferens. Because several clinical studies have shown that tamsulosin causes ejaculatory disorders, this study also evaluated the possible mechanisms implicated in these disorders by comparing the effect of tamsulosin with that of alfuzosin. Tamsulosin competitively antagonized the contractions induced by noradrenaline in vitro in the epididymal portion of the vas deferens with a potency pA(2) value of 9.2 +/- 0.8. In the prostatic portion, tamsulosin increased the amplitude of intermittent spikes induced by exogenous noradrenaline (100-1000 microM). In both portions of the vas deferens, alfuzosin behaved as an alpha-adrenergic antagonist blocking the contractions induced by exogenous noradrenaline without altering spikes. The administration of tamsulosin (3 microg/kg i.v.) significantly reduced the contractions evoked by electrical pulses in the epididymal portion, whereas it increased those produced in the prostatic portion. Intravenous tamsulosin antagonized the contraction produced by exogenous noradrenaline, whereas alfuzosin administration (10 microg/kg i.v.) did not change the electrically induced contractions in both portions of the rat vas deferens and did not antagonize the contractions produced by exogenous noradrenaline. The fact that tamsulosin unusually enhances noradrenaline-induced intermittent spike contractions and nerve stimulation-induced twitches in the prostatic portions might be linked to its greater propensity to cause sexual dysfunctions.
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Affiliation(s)
- Simone Tambaro
- Neuroscienze PharmaNess Scarl, Via Palabanda 9, 09124 Calgliari, Italy
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Yolcu OF, Köklü S, Köksal AS, Yüksel O, Beyazit Y, Basar O. Alfuzosin-induced acute hepatitis in a patient with chronic liver disease. Ann Pharmacother 2004; 38:1443-5. [PMID: 15280514 DOI: 10.1345/aph.1d633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report a new case of probable alfuzosin-induced hepatitis. CASE SUMMARY An 80-year-old man was evaluated because of jaundice and pruritus. He was diagnosed as having Child-Pugh A chronic liver disease due to hepatitis B virus. Other etiologies of hepatitis were appropriately ruled out, and the hepatitis B was non-replicative. Therefore, elevated liver enzyme levels were ascribed to alfuzosin treatment. DISCUSSION Although alfuzosin-related mixed-type hepatotoxicity has been previously reported, this is the first published case describing probable hepatocellular-type hepatotoxicity resulting from use of alfuzosin in a patient with underlying chronic liver disease. According to the Naranjo probability scale, alfuzosin was a probable cause of the hepatotoxicity. The mechanism of alfuzosin-induced liver damage is unknown. Several features, such as absence of predictable dose-dependent toxicity of alfuzosin in previous studies and absence of hypersensitivity manifestations in our case, are suggestive of a metabolic type of idiosyncratic toxicity. CONCLUSIONS Alfuzosin rarely causes hepatotoxicity; however, clinicians must be alert for this adverse effect while using alfuzosin.
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Affiliation(s)
- Omer Faruk Yolcu
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. ,
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Kaplan SA. Use of alpha-adrenergic inhibitors in treatment of benign prostatic hyperplasia and implications on sexual function. Urology 2004; 63:428-34. [PMID: 15028431 DOI: 10.1016/j.urology.2003.09.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Accepted: 09/18/2003] [Indexed: 10/26/2022]
Affiliation(s)
- Steven A Kaplan
- Department of Urology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA
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Guay DRP. Extended-release alfuzosin hydrochloride: A new alpha-adrenergic receptor antagonist for symptomatic benign prostatic hyperplasia. ACTA ACUST UNITED AC 2004; 2:14-23. [PMID: 15555475 DOI: 10.1016/s1543-5946(04)90003-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extended-release (ER) alfuzosin hydrochloride is the most recently approved alpha-adrenergic receptor antagonist (AARA) for the management of symptomatic benign prostatic hyperplasia (BPH). Although new to the United States, alfuzosin has been available in immediate-release (IR) and sustained-release (SR) formulations in other countries for many years. OBJECTIVE This article reviews data on the pharmacodynamics, pharmacokinetics, efficacy, tolerability, drug-interaction potential, and dosing of alfuzosin ER. METHODS Relevant articles were identified through MEDLINE, EMBASE, and International Pharmaceutical Abstracts searches of the English-language literature published between 1986 and September 2003 using the terms alfuzosin, alpha-adrenergic receptor antagonists, and quinazolines. The reference lists of identified articles were also searched, as were abstracts from annual meetings of the American Urological Association for the past 5 years. Data regarding the ER formulation were emphasized, and data involving the IR/SR formulations were included only when data for the ER formulation were not available or as needed for clarification. RESULTS In comparative trials with its IR counterpart (alfuzosin ER 10 mg QD vs alfuzosin IR 2.5 mg TID), alfuzosin ER was an equieffective once-daily AARA. No comparative trials of alfuzosin ER with the SR (BID) formulation or with other AARAs were identified. Food has been found to exert a clinically important effect by enhancing the bioavailability of the ER formulation; thus, the drug should be taken on a full stomach. Hepatic impairment has been found to significantly delay the elimination of alfuzosin IF, which constitutes a contraindication to use of the ER formulation. Renal impairment does not appear to exert clinically important effects on the pharmacokinetics of alfuzosin ER. Adverse events with alfuzosin ER include dizziness, upper respiratory tract infection, headache, and fatigue, with hypotension and syncope reported rarely. Concurrent use of inhibitors of the cytochrome P450 3A4 isozyme (eg, ketoconazole, diltiazem, cimetidine, atenolol) can significantly elevate serum concentrations of alfuzosin and enhance its pharmacodynamic effects. CONCLUSIONS In the absence of direct head-to-head comparative trials, the role of alfuzosin ER in the management of symptomatic BPH relative to that of other AARAs is unclear. Because the effect size (drug response minus placebo response) of alfuzosin ER is comparable to that of other AARAs, marked differences in efficacy are unlikely. Extrapolating from direct comparative trials between these agents and alfuzosin IR/SR, alfuzosin ER would be expected to have better cardiovascular tolerability (eg, in terms of dizziness and orthostasis) than prazosin, terazosin, or doxazosin, and to have similar tolerability to tamsulosin. However, the existing data do not suggest that alfuzosin ER is likely to represent a significant advance over tamsulosin.
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Affiliation(s)
- David R P Guay
- Department of Experimental and Clinical Pharmacology, Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota, MN 55455, USA.
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Giuliano F, Bernabe J, Droupy S, Alexandre L, Allard J. A comparison of the effects of tamsulosin and alfuzosin on neurally evoked increases in bladder neck and seminal vesicle pressure in rats. BJU Int 2004; 93:605-8. [PMID: 15008740 DOI: 10.1111/j.1464-410x.2003.04674.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the effects of the alpha 1-adrenoceptor antagonists alfuzosin and tamsulosin on the physiological events associated with ejaculation in the rat, because when these drugs are used for treating symptomatic benign prostatic hyperplasia in men they may affect ejaculation by impairing bladder neck closure and seminal vesicle contraction. MATERIALS AND METHODS In clinical trials the incidence of ejaculatory disorders in men is typically < 1% with alfuzosin and 4-18% with tamsulosin. The effects of tamsulosin and alfuzosin on bladder neck and seminal vesicle pressures (BNP and SVP) in the rat were analysed. Increases in BNP and SVP were induced in urethane-anaesthetized. Wistar rats by electrical stimulation (ES) of the hypogastric nerve (HN) before and after an intravenous injection with vehicle, 3 or 10 micrograms/kg of tamsulosin or alfuzosin (10 rats/group). The mean amplitude and area under the curve (AUC) of the BNP and SVP were expressed as the percentage of the response to ES of HN before the treatment. RESULTS The amplitude and AUC of the SVP were significantly decreased by both doses of tamsulosin, and marginally decreased by the same doses of alfuzosin. The amplitude of the BNP was significantly decreased by 3 and 10 micrograms/kg of tamsulosin and 10 micrograms/kg alfuzosin, and marginally decreased by 3 micrograms/kg alfuzosin. The AUC of the BNP was significantly decreased by both doses of tamsulosin, but barely affected by alfuzosin at the same doses. CONCLUSION Over the doses assessed, alfuzosin had significantly less deleterious effect on increases in BNP and SVP induced by ES of the HN than had tamsulosin.
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Affiliation(s)
- F Giuliano
- Pelvipharm Laboratories, CNRS, Gif-sur-Yvette, France.
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Roehrborn CG, Schwinn DA. α1-Adrenergic Receptors and Their Inhibitors in Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia. J Urol 2004; 171:1029-35. [PMID: 14767264 DOI: 10.1097/01.ju.0000097026.43866.cc] [Citation(s) in RCA: 210] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We provide a comprehensive overview of the role of alpha1-adrenergic receptors (alpha1ARs) as critical mediators of lower urinary tract symptoms (LUTS) and pathophysiology in benign prostatic hyperplasia (BPH), and we review the pharmacological antagonists of alpha1ARs. MATERIALS AND METHODS A review was performed of pertinent studies in the literature relating to the pathophysiology of LUTS and BPH, focusing on the role of alpha1ARs, and of clinical trial and practice data evaluating the different agents that inhibit these receptors. RESULTS Further characterization of the alpha1AR gene family indicates that 3 receptor subtypes exist in humans. Their different distribution between urinary tract and cardiovascular tissues has provided a strategy for the development of improved therapeutic agents. Since excessive activity of the alpha1aAR and alpha1dAR subtypes appears to be a common feature in symptomatic BPH and alpha1aARs are enriched in prostatic tissue, drugs that demonstrate high alpha1aAR selectivity have attracted attention. Tamsulosin, which has high affinity for alpha1aAR and alpha1dAR subtypes but not for alpha1bAR, shows efficacy similar to the nonsubtype selective agents terazosin and doxazosin. It is associated with fewer cardiovascular side effects, although it has some ejaculatory side effects. The nonsubtype selective agent alfuzosin also demonstrates efficacy and offers an enhanced side effect profile, particularly minimizing hypotension. Other agents with super selective specificity for the alpha1aAR subtype are under investigation. CONCLUSIONS Further advances in the treatment of LUTS associated with BPH may depend not only on receptor subtype selectivity, but also on other pharmacokinetic and pharmacodynamic factors.
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Affiliation(s)
- Claus G Roehrborn
- University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9110, USA.
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Marks LS, Roehrborn CG, Gittelman M, Kim D, Forrest J, Jacobs S. First dose efficacy of alfuzosin once daily in men with symptomatic benign prostatic hyperplasia. Urology 2003; 62:888-93. [PMID: 14624914 DOI: 10.1016/s0090-4295(03)00657-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the onset of action of alfuzosin once daily (OD) as determined by uroflowmetry early after initial dosing. Alfuzosin OD is an extended-release formulation of a uroselective, alpha1-adrenoreceptor-blocking agent (alpha-blocker) used in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. METHODS This was a randomized, placebo-controlled, two-way Latin square crossover study. Forty-nine patients were selected for this study on the basis of their symptomatic improvement during previous treatment with alpha-blockers and significant decreases in urinary flow rate when that treatment was withdrawn. RESULTS Our analysis showed that significant increases in the maximal urinary flow rate (Qmax) in 34 assessable patients occurred as soon as 8 hours after the initial dose of medication and persisted for at least 4 days. The DeltaQmax for alfuzosin 10 mg OD was 3.2 mL/s and for placebo it was 1.1 mL/s. The difference of means for the assessable population was 2.1 (95% confidence interval 0.8 to 3.4, P = 0.002). The overall incidence of adverse events was low. Only dizziness, experienced by 3 patients treated with alfuzosin compared with 1 patient treated with placebo, appeared to be related to the study drug. CONCLUSIONS Together, our findings suggest that alfuzosin OD exhibits a urodynamically measurable effect on bladder outlet obstruction due to benign prostatic hyperplasia in men with lower urinary tract symptoms within hours of the first administration.
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Affiliation(s)
- Leonard S Marks
- Urological Sciences Research Foundation and Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles, California 90232, USA
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