5ARIs have shown to reduce disease progression, prevent complications from benign prostatic hyperplasia (including acute urinary retention and prostate related surgery), and improve lower urinary tract symptoms starting after six months of treatment.2 Although effective, when initiated, blockers can induce marked orthostatic hypotension and syncope.3 This effect was labeled the « first dose phenomenon » by Bendall and colleagues in men using prazosin in 1975,4 and subsequently has been reported in antagonists to the 1 adrenergic receptor, terazosin and doxazosin.5 This effect is a consequence of inadvertent vasodilation and a decrease in systemic vascular resistance. A recent study found an increased risk of hip fracture among men taking blockers but not 5ARIs, suggesting that it may have resulted from an increased risk of hypotension induced falls.6 Tamsulosin is a uroselective blocker owing to its selectivity as an 1a receptor antagonist, which is the predominant receptor that mediates prostate smooth muscle tension.7 Compared to non selective 1 blockers such as terazosin and doxazosin Fake Hermes, tamsulosin has a lower rate of asthenia, dizziness, and severe hypotension in clinical trials.8 As a result Hermes Replica, it has a warning for hypotension and syncope, but not a black box warning similar to less selective blockers in its class.It is unknown whether tamsulosin treatment induces a first dose phenomenon in clinical practice and confers increased risk for hypotension, requiring admission to hospital immediately after initiating or restarting drug treatment. Our study aimed to characterize the risk of severe hypotension at time varying intervals during the course of tamsulosin treatment in middle aged and older men with benign prostatic hyperplasia.MethodsData sourceThe IMS Lifelink database contains paid claims from over 102 healthcare plans in the US.
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