Question 3 is targeted at only the patients who exercised sexual actions and had the chances of ejaculation even after taking oral silodosin, more concretely, to investigate the presence or absence of ejaculatory disorder and frequency, changes and prevalence in the amount of semen at the time of ejaculation. The last question was whether or not the patients wished to discontinue oral silodosin because of the ejaculatory disorder.
Each of the items including the prostate volume before silodosin administration, the international prostate symptom score IPSS and QOL score before and after 4 weeks from administration, were investigated in the 91 patients who responded to the questionnaire.
Questionnaires were administered in this hospital and a fixed doctor has completed the questionnaires with interview form. This research was approved in the ethical committee in our hospital and all patients were consented to this research. The questionnaire survey was conducted in the patients who had been taking oral silodosin for over 4 weeks from the start.
All 91 patients completed the questionnaire survey. Incidence of ejaculatory disorder in all patients and sexually active patients. Ejaculatory disorder present fully shaded area. On each time fully shaded area. Loss of semen emission fully shaded area. I do not worry and want to continue the medication fully shaded area. I worry but want to continue the medication slightly shaded area. I worry and want to discontinue the medication non shaded area.
After discontinuation of intake of silodosin, the all patients who had ejaculatory disorder recovered their ejaculatory function. The incidence of ejaculatory disorder is mostly reported on the basis of adverse reaction reports in the clinical trials. Yokoyama et al. Kawabe et al. The incidence of ejaculatory disorder is expected to go up further if the survey was conducted only in the patients carrying out sexual actions.
The questionnaire table this time was prepared on our own and it is not a validated one. However, this questionnaire survey among the patients who had taken the oral silodosin at the standard dose prescribed in Japan clearly showed ejaculatory disorder was induced by silodosin at a very high rate.
Accordingly, it is considered necessary to include the presence or absence of sexual actions sexual intercourse, masturbation in the survey of the incidence of ejaculatory disorder. Hisasue et al. They reported that the ejaculation volume and fructose in the semen decreased, and that no sperm was observed in the urine after ejaculation by the influence of tamuslosin [ 9 ].
Hellstorm et al. Based on the above, the ejection disorder due to the insufficient contraction of seminal vesicle and spermatic duct is conceivable as the mechanism of ejaculatory disorder by tamuslosin.
Furthermore, Nagai et al. They reported that the mechanism of ejaculatory disorder is intricately related to retrograde ejaculation retrograde inflow of semen fluid , insufficient contraction of the seminal vesicles, and insufficient rhythmic contraction of the muscles of the pelvic floor [ 12 ]. Furuya et al. Furthermore, higher rate of ejaculatory disorder was observed in silodosin receiving patients compared with tamsulosin or naftopidil receiving patients [ 8 ]. Even if ejaculatory disorder occurs, discontinuation of oral silodosin is not necessarily required if the QOL of patient himself is not decreased because of this disorder.
Homma et al. Roehrborn et al. These results suggest that ejaculatory disorder caused by silodosin associated with very large improvements in patients with benign prostatic hyperplasia. Ejaculatory disorder occurs via interference in the muscle contraction of the vas deferens and seminal vesicle, patients can still engage in sexual intercourse and experience satisfying orgasm [ 17 ].
While Shimizu et al. Taking these drugs together is not recommended. These medications may cause your blood pressure to become too low if taken with silodosin. They may also increase your risk of orthostatic hypotension, which is a sudden drop in blood pressure when getting up after sitting or lying down.
This condition can cause dizziness or fainting. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Taking it again could be fatal cause death. If you drink grapefruit juice while taking silodosin, it may increase the levels of silodosin in your body and possibly cause increased side effects.
Talk to your doctor about whether grapefruit products are safe for you. Silodosin can make you dizzy. Consuming alcohol may also make you dizzy and drowsy.
You should limit the amount of alcohol you drink. For people with kidney disease: Your body gets rid of this drug partly through your kidneys. This increases your risk of side effects. If you have moderate kidney disease, your doctor may give you a lower dosage. For people with liver disease: This drug is processed by your liver. For people with low pressure hypotension : This drug may cause low blood pressure when you stand up after sitting or lying down, dizziness, and even further lowering of your blood pressure.
For pregnant women: This drug is used to treat BPH in men. For women who are breastfeeding: This drug is used to treat BPH in men. All possible dosages and forms may not be included here.
Your dose, form, and how often you take it will depend on:. As you age, your organs such as liver or kidneys may not work as well. Your body may process this drug more slowly. Too much drug in your body can lead to more side effects. Based on how well your liver and kidneys are working, your doctor may decide to adjust your dosage, or not prescribe this drug at all. For people with kidney disease: Dosing for silodosin depends on your kidney function.
However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. Always speak with your doctor or pharmacist about dosages that are right for you. Silodosin is used for long-term treatment. If you stop or forget to take this medication for several days, talk with your doctor before starting again.
If you take too much: You may experience low blood pressure, especially when you stand up after sitting or lying down. Symptoms may include:. But if your symptoms are severe, call or go to the nearest emergency room right away.
What to do if you miss a dose: If you miss a dose, take it as soon as you can. Never try to catch up by taking two capsules at once. This could result in dangerous side effects. How to tell if the drug is working: Your BPH symptoms should improve. You may have an easier time urinating. A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.
To help reduce the symptoms of BPH, your doctor may instruct you to limit the amount of fluid you drink at night. They may also recommend that you reduce the amount of alcohol and caffeine you drink. Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacies carries it. These percentages are much higher than that of the placebo group, which was 0. These frequencies suggest a dose-related effect of tamsulosin on ejaculatory function.
Two studies in conducted in healthy men have suggested that tamsulosin causes decreased ejaculate volume, sometimes to the point of anejaculation 16 , A pooled analysis of several European phase II trials found abnormal ejaculation to be more frequent in patients younger than 65 years of age 6.
However, the frequency of abnormal ejaculation in both of these groups did not reach statistical significance in comparison to the placebo group The effect of the uroselective tamsulosin relaxes the tone of smooth muscles of the bladder neck, thus reducing the pressure proximally to the verumontanum, leading to retrograde ejaculation.
Sometimes due to the reduced amount or complete absence of the ejaculate, the extent of sensory stimuli coming from posterior urethra responsible for orgasm is reduced Still, alfuzosin exhibits selective action in the urinary tract likely due to preferential distribution into the prostate gland versus the blood and limited ability to penetrate the blood brain barrier As per the prescribing information, adverse event data was obtained from three placebo-controlled clinical trials that were conducted over a three-month time period and involved 1, men, of whom received one alfuzosin 10 mg extended-release tablet daily while the remaining 1, received 15 mg daily Decrease in erectile function based on a meta-analysis of randomized controlled and open label trials has been reported to be between 0.
In comparison, the patients receiving a placebo in these trials reported decreases in erectile function at rates ranging from 0—2. A meta-analysis of randomized controlled trials including a total of 1, patients demonstrated incidences of decreased sexual desire in 0—0. Priapism was reported after market approval so incidence was not reported for this adverse effect The reported incidence of ejaculatory disorders with the use of alfuzosin is generally less than 1. No dose-effect relationship was observed with alfuzosin and the incidence of sexual side effects The mean improvements from baseline in these two conditions were greater for men with more severe LUTS and BPH at baseline than men with milder symptoms Further, alfuzosin is well tolerated when used in combination with low doses of PDE5 inhibitors for ED A six-month open label study conducted in 42 men demonstrated that the side effect profile of alfuzosin in combination with tadalafil was similar to that with each agent alone The effective mechanism through which the alpha1 A selective antagonists cause these symptoms of sexual dysfunction is unknown 9.
However, several theories have been proposed. The first theory is that these selective alpha1 A antagonists may affect the emission phase of ejaculation by blocking alpha1 A selective antagonists in the organs involved in this process — the seminal vesicles and the vas deferens 9.
As the seminal vesicles are a major contributor to the volume of semen, this effect may an example of some of the EjD observed with the use of tamsulosin Nevertheless, the effect observed in rats may not necessarily carry over to human subjects. Thus, patients experience retrograde ejaculation or decreased ejaculate volume. These effects are reversible with drug discontinuation Effects of alpha adrenergic antagonists on blood pressure may also cause ED Tamsulosin has also shown a strong affinity for the 5-HT 1A and D 2 receptors which are both involved in the central control of ejaculation This mechanism would again explain the highly reported frequency of abnormal ejaculation with tamsulosin in comparison with other BPH medications.
It has been assumed by many researchers and healthcare providers that the EjD caused by ABs was due to retrograde ejaculation. The previously mentioned study in rats also demonstrated that tamsulosin had a significantly greater inhibitory effect on bladder neck closure and seminal vesicle contractions than alfuzosin Thus, because alpha adrenergic antagonists relax the bladder neck, they may allow semen to flow into the bladder during ejaculation.
However, a few studies have found evidence to contradict the idea that tamsulosin causes retrograde ejaculation. A study of 17 Korean urologists demonstrated that treatment with tamsulosin 0.
However, no sperm was found in mid-stream urine collected after ejaculation Another study included 57 healthy volunteers treated for five days with either placebo, tamsulosin 0. These researchers postulated how direct effects of tamsulosin and alfuzosin may be responsible for improvements in sexual functioning.
These ideas were based on data from animals and in vitro trials, so their relevance in humans is not definitive. In precontracted rat corpora cavernosum, alfuzosin was found to fully relax cavernosal tissue in vitro Further, tamsulosin was second only to prostaglandin E 1 in its enhancing effect on small muscle relaxation of the corpus cavernosum of dogs, rabbits, and humans in vitro when it was compared to other substances such as phentolamine Thus, the effects of tamsulosin and other ABs on sexual health might not always be negative.
It is selective for adrenoceptors in the prostate and bladder. By causing a blockage of these receptors, there is a relaxation of smooth muscle in the bladder neck and prostate, which results in an improvement of urine flow and decreased symptoms of BPH
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