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Nov 11, 2020
3 min read

Tamsulosin (Flomax) interactions: what you need to know

CYP3A4 and CYP2D6 are two enzymes in the liver that break down tamsulosin. Any drug that blocks or inhibits CYP3A4 and CYP2D6 can increase the concentration of tamsulosin in the body. This can increase the likelihood of developing adverse effects, like hypotension and syncope (fainting).

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Tamsulosin (brand name Flomax) is a medication used to treat benign prostatic hyperplasia (BPH). As with many medications, potential drug interactions may occur with tamsulosin. It’s important to tell your healthcare provider about all medications (both prescription and nonprescription), supplements, and herbal products you’re taking before beginning a new medication.

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What is tamsulosin?

Tamsulosin (brand name Flomax) is an alpha-blocker that’s FDA-approved to treat the urinary symptoms of BPH, also referred to as an enlarged prostate. You can only get it with a prescription, but it is available as either generic tamsulosin or brand name Flomax.

Tamsulosin drug interactions

Sildenafil and other PDE5 inhibitors

Phosphodiesterase-5 (PDE5) inhibitors are oral medications used to treat erectile dysfunction (ED). They work by dilating blood vessels to allow more blood flow into the penis, improving your erection. However, dilating blood vessels also lowers blood pressure. Taking both tamsulosin and PDE5 inhibitors may low blood pressure, also called hypotension (DailyMed, 2017). Examples of PDE5 inhibitors include sildenafil (brand name Viagra; see Important Safety Information), tadalafil (brand name Cialis; see Important Safety Information), vardenafil (brand name Levitra), and avanafil (brand name Stendra). Ask your healthcare provider if it’s safe to take a PDE5 inhibitor while taking tamsulosin.

CYP3A4 and CYP2D6 blockers 

CYP3A4 and CYP2D6 are two enzymes in the liver that break down tamsulosin. Any drug that blocks or inhibits CYP3A4 and CYP2D6 can increase the concentration of tamsulosin in the body. This can increase the likelihood of developing adverse effects, like hypotension and syncope (fainting) (DailyMed, 2017). In some cases, your healthcare provider may adjust your medication dose. Examples of these drugs include cimetidine, ketoconazole, erythromycin, terbinafine, and paroxetine.

Blood pressure medications

Since tamsulosin may lower your blood pressure, you should be careful while being treated for high blood pressure. If you’re already taking medication for high blood pressure (hypertension), ask your healthcare provider if it’s safe for you to take tamsulosin as well. Taking tamsulosin along with blood pressure medications can increase the risk of orthostatic hypotension (OH), which is dizziness or fainting upon standing; these symptoms are due to a sudden drop in blood pressure (Biaggioni, 2018).

Tamsulosin uses

Tamsulosin is FDA-approved to relieve symptoms of benign prostatic hyperplasia (BPH), otherwise known as an enlarged prostate (DailyMed, 2017). As men get older, their prostates naturally get larger. In some men, this can put pressure on the urethra and bladder, partially obstructing the flow of urine. This can cause symptoms like:

  • Increased need to urinate, particularly at night
  • Difficulty urinating (straining, frequent starting and stopping)
  • Weak urine stream
  • Trouble beginning urination

Tamsulosin causes smooth muscles in the prostate and bladder to relax, making urination easier.

Tamsulosin is also prescribed “off-label” for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and kidney stones that have moved into the urethra (UpToDate, n.d.). By causing smooth muscles in the area to relax, tamsulosin can help dislodge those stones, allowing them to be passed naturally in the urine stream.

Tamsulosin drug class

Tamsulosin (or tamsulosin hydrochloride) is part of a class of drugs called alpha blockers, also called selective alpha-1a adrenergic receptor antagonists (NIDDK, 2018). Tamsulosin targets receptors in the smooth muscles of the prostate and bladder, causing them to relax, thereby improving symptoms.

Other examples of alpha blockers include alfuzosin (brand name Uroxatral), doxazosin (brand name Cardura), silodosin (brand name Rapaflo), and terazosin (brand name Hytrin).

Tamsulosin side effects

Like many medications, tamsulosin can cause side effects. These can range from mild to serious.

Common side effects of tamsulosin include:

  • Headache
  • Dizziness 
  • Abnormal ejaculation
  • Runny nose or nasal congestion
  • Drowsiness
  • Back pain
  • Stomach upset, diarrhea, and nausea 

Less common side effects of tamsulosin include 

  • Orthostatic hypotension, which is dizziness, lightheadedness, or fainting (syncope) when moving from a sitting to standing position. It’s caused by a sudden drop in blood pressure.
  • Chest pain
  • Loss of libido
  • Intraoperative floppy iris syndrome (IFIS) which can occur during glaucoma surgery or cataract surgery. 
  • Priapism, a painful erection that lasts more than four hours

Some people who are allergic to sulfonamides, or sulfa drugs, may also have an allergic reaction to tamsulosin. Allergic reactions may include a skin rash, swelling, or trouble breathing. 

This is not a complete list of side effects. Seek medical advice from your healthcare professional or pharmacist if you have questions about tamsulosin side effects or drug interactions.

References

  1. American Urology Association (AUA). (2020). Urology Care Foundation: What is benign prostatic hyperplasia?. Retrieved on Sep. 8, 2020 from https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)
  2. Biaggioni, I. (2018). Orthostatic Hypotension in the Hypertensive Patient. American Journal of Hypertension, 31(12), 1255–1259. https://doi.org/10.1093/ajh/hpy089. Retrieved from https://academic.oup.com/ajh/article/31/12/1255/5047643 
  3. DailyMed. (n.d.). FLOMAX- tamsulosin hydrochloride capsule. Retrieved Sep. 10, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c00d5f7b-dad7-4479-aae2-fea7c0db40ed
  4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2018). Alpha 1 Adrenergic Receptor Antagonists. In LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31644028/
  5. UpToDate. (n.d.). Tamsulosin: Drug information. Retrieved on Sep. 8, 2020 from https://www.uptodate.com/contents/tamsulosin-drug-informatio