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Urology/Is there any problem for the patient taking the non-selective alpha-blockers who has no heart disease problems?

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QUESTION: I have been diagnosed with the bladder outlet obstruction due to the enlarged prostate. I have tried the Cardura, Alfuzosin, Flomax and Rapflo and feel the selective alpha-blockers can only give smooth urine flow but no help to relieve the lower abdominal pain(due to the pressure). But, the non-selective alpha-blockers Cardura not only gives the smooth urine flow but also relieves the lower abdominal pain (due to the pressure). I read the non-selective alpha-blockers are preferred to give the patient with the high blood pressure problems. But, I do not have such a disease at all. Is there any problem for the patient taking the Cardura for a long time, who has no heart disease problems or there is an other option? Thank you for your answer.

ANSWER: Luo:

There is no problem giving the non-selective agents to patients without hypertension except that they are more prone to dizziness from low blood pressure and the dosage therefore needs to be advanced slowly.  Non-selective agents are also far less expensive which is a benefit.  In the unlikely case that your blood pressure is lowered on these agents to the point of causing problems, you might have to switch but this would be unusual.

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QUESTION: Thanks for your answer. I do not know why the non-selective alpha blockers Cardura can relieve my lower abdominal pain while the selective alpha blockers canít though both of non-selective and selective alpha blockers can give smooth urine flow. So I have to think I may have overactive bladder problems too because I read the terazosin or doxazosin may help in the treatment of the overactive bladder. The non-selective alpha blockers relax the muscles around entire bladder while the selective alpha blockers only relax the prostate and bladder neck muscles. Can you provide your opinion?

ANSWER: Luo:

Terazosin and doxazosin are not effective for overactive bladder but since they seem to work better for you I would just use them and be grateful they work.

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QUESTION: My urologist prescribed the doxazosin 4mg per day but primary care physician did 2 mg. Should the patient start the doxazosin 4 or 2 mg and why? Thank you for your answer.

Answer
Luo:

Doxazosin is a drug that is best started low and then increased to avoid dizziness and other complications.  I would recommend starting at the 2 mg level and give your system time to adjust.  If you get an acceptable result at just 2 mg, then it's reasonable to stop there.  If not, then it can be increased to the usual dose of 4 mg or even the maximum of 8 mg.  Typically, the drug is usually taken just before bed at night.  THis also helps reduce some side effects.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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