Abstract
We describe pronounced hypotension in a patient during orthostatic testing while receiving treatment with sildenafil and tamsulosin, but not with placebo. The patient was 71 years of age and had no history of orthostatic reactions. He had been diagnosed with benign prostatic hyperplasia (BPH) and glaucoma simplex (open-angle glaucoma). The only regular medication used was a combination of latanoprost and timolol one drop daily into each eye. The patient was among 16 men with BPH enrolled in a study of the haemodynamic effects of tamsulosin and sildenafil. The present patient was excluded from data analysis because of atypical reactions: he experienced a decrease in peripheral vascular resistance upon orthostasis during treatment with sildenafil and tamsulosin. This led to marked hypotension and cancellation of the tilt tests with both sildenafil alone (Riva-Rocci [RR] 75/50mm Hg) and a combination of sildenafil and tamsulosin (RR 60/45mm Hg); however, tamsulosin alone also lowered blood pressure to some extent (RR 100/80mm Hg). In conclusion, even though sildenafil and tamsulosin are considered haemodynamically safe, they may induce considerable vasodilation and, subsequently, harmful hypotension in susceptible patients.
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Kloner RA. Novel phosphodiesterase type 5 inhibitors: assessing hemodynamic effects and safety parameters. Clin Cardiol 2004 Apr; 27(4 Suppl. 1): I20–5
Zusman RM, Morales A, Glasser DB, et al. Overall cardiovascular profile of sildenafil citrate. Am J Cardiol 1999 Mar 4; 83(5A): 35C–44C
Wilt TJ, MacDonald R, Nelson D. Tamsulosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects. J Urol 2002 Jan; 167(1): 177–83
Kööbi T, Kaukinen S, Ahola T, et al. Non-invasive measurement of cardiac output: whole-body impedance cardiography in simultaneous comparison with thermodilution and direct oxygen Fick methods. Intensive Care Med 1997 Nov; 23(11): 1132–7
Imholz BP, van Montfrans GA, Settels JJ, et al. Continuous non-invasive blood pressure monitoring: reliability of Finapres device during the Valsalva manoeuvre. Cardiovasc Res 1988 Jun; 22(6): 390–7
Nichols DJ, Muirhead GJ, Harness JA. Pharmacokinetics of sildenafil after single oral doses in healthy male subjects: absolute bioavailability, food effects and dose proportionality. Br J Clin Pharmacol 2002; 53Suppl. 1: 5S–12S
Matsushima H, Kamimura H, Soeishi Y, et al. Pharmacokinetics and plasma protein binding of tamsulosin hydrochloride in rats, dogs, and humans. Drug Metab Dispos 1998 Mar; 26(3): 240–5
Guimaraes S, Moura D. Vascular adrenoceptors: an update. Pharmacol Rev 2001 Jun; 53(2): 319–56
Mukai S, Lipsitz LA. Orthostatic hypotension. Clin Geriatr Med 2002 May; 18(2): 253–68
Nieminen T, Uusitalo H, Turjanmaa V, et al. Association between low plasma levels of ophthalmic timolol and haemodynamics in glaucoma patients. Eur J Clin Pharmacol 2005 Jul; 61(5-6): 369–74
Fraunfelder FT, Barker AF. Respiratory effects of timolol [letter]. N Engl J Med 1984 Nov 29; 311(22): 1441
Wallis RM, Corbin JD, Francis SH, et al. Tissue distribution of phosphodiesterase families and the effects of sildenafil on tissue cyclic nucleotides, platelet function, and the contractile responses of trabeculae carneae and aortic rings in vitro. Am J Cardiol 1999 Mar 4; 83(5A): 3C–12C
Kloner RA, Jackson G, Emmick JT, et al. Interaction between the phosphodiesterase 5 inhibitor, tadalafil and 2 alpha-blockers, doxazosin and tamsulosin in healthy normotensive men. J Urol 2004 Nov; 172(5 Pt 1): 1935–40
Auerbach SM, Gittelman M, Mazzu A, et al. Simultaneous administration of vardenafil and tamsulosin does not induce clinically significant hypotension in patients with benign prostatic hyperplasia. Urology 2004 Nov; 64(5): 998–1003
Nieminen T, Tammela T, Kööbi T, et al. The effects of tamsulosin and sildenafil in separate and combined regimens on detailed hemodynamics in patients with benign prostatic enlargement. J Urol. In press
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Financial support has been received from the Medical Research Fund of Tampere University Hospital. None of the authors have any conflicts of interest.
Study nurse Pirjo Järventausta is acknowledged for her skilful technical assistance.
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Nieminen, T., Kööbi, T., Tammela, T.L.J. et al. Hypotensive Potential of Sildenafil and Tamsulosin during Orthostasis. Clin. Drug Investig. 26, 667–671 (2006). https://doi.org/10.2165/00044011-200626110-00007
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DOI: https://doi.org/10.2165/00044011-200626110-00007