Flomaxtra XL

Flomaxtra XL contains tamsulosin hydrochloride in a modified-release formulation, prescribed for the management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).

It is one of the most commonly prescribed alpha-blockers for this condition in the United Kingdom.

Tamsulosin selectively blocks alpha-1A adrenoceptors in the smooth muscle of the prostate gland, prostatic capsule, and bladder neck.

By relaxing this smooth muscle, it reduces the dynamic component of urinary obstruction, improving urinary flow and relieving symptoms such as hesitancy, weak stream, frequency, urgency, and nocturia.

Because tamsulosin is selective for alpha-1A receptors (predominant in the prostate) rather than alpha-1B receptors (predominant in blood vessels), it causes less systemic blood pressure lowering than non-selective alpha-blockers such as doxazosin.

This selectivity makes it generally well tolerated, with a lower incidence of postural hypotension.

Flomaxtra XL provides prolonged drug release over 24 hours, enabling once-daily dosing. It does not shrink the prostate; its benefit is purely symptomatic.

Men with large prostates at risk of disease progression may benefit from combination therapy with a 5-alpha reductase inhibitor such as dutasteride or finasteride.

Take one capsule daily, approximately 30 minutes after breakfast or the first meal of the day.

Swallow the capsule whole without crushing or chewing, as this would destroy the modified-release mechanism.

Take the capsule at approximately the same time each day to maintain steady drug levels. If you miss a dose, take it as soon as you remember after your next meal, but do not double up.

Continue treatment for as long as your prescriber advises. Stopping tamsulosin may cause a return of urinary symptoms within a few days.

One 400 microgram modified-release capsule once daily, taken after a meal. No dose titration is required, and there is no alternative dose within this formulation.

No dose adjustment is needed for mild to moderate renal impairment. In severe renal impairment (creatinine clearance below 10 mL/min), use with caution.

Tamsulosin is not recommended in severe hepatic impairment. Elderly patients do not require dose adjustment.

Dizziness affects approximately 3 to 5 per cent of patients and may be more noticeable during the first few days of treatment.

Postural hypotension (a drop in blood pressure on standing) can occur, though it is less frequent with tamsulosin than with non-selective alpha-blockers.

Abnormal ejaculation, including reduced ejaculatory volume and retrograde ejaculation, is reported in approximately 4 to 10 per cent of men. This effect is reversible on stopping the medication.

Headache, nasal congestion, rhinitis, and asthenia (weakness) are other commonly reported effects. Gastrointestinal symptoms such as nausea, constipation, and diarrhoea occur occasionally.

Intraoperative floppy iris syndrome (IFIS) is a recognised complication during cataract surgery and may occur even after tamsulosin has been discontinued.

Rarely, priapism and severe hypersensitivity reactions have been reported.

Inform your ophthalmologist that you are taking or have previously taken tamsulosin before any cataract surgery, as intraoperative floppy iris syndrome may affect the surgical approach.

Be cautious when changing position from sitting or lying to standing, particularly at the start of treatment, as blood pressure may drop. Avoid driving or operating machinery if you feel dizzy.

Tamsulosin should be prescribed with caution alongside other alpha-blockers or blood pressure-lowering medications.

Concurrent use with strong CYP3A4 inhibitors such as ketoconazole may increase tamsulosin exposure.

Flomaxtra XL is contraindicated in patients with known hypersensitivity to tamsulosin or any excipient.

It must not be used in patients with a history of orthostatic hypotension or severe hepatic impairment.

Tamsulosin is intended for men only and is not indicated for the treatment of hypertension.