Alfuzosin hydrochloride Nursing Considerations & Management

Drug Name

Generic Name: alfuzosin hydrochloride

(al foo zow‘ sin)

Brand Name: Uroxatral

Pregnancy Category B

Drug classes

• Alpha adrenergic blocking agent
• BPH drug

Therapeutic actions

Blocks the smooth muscle alpha-1 adrenergic receptors in the prostate, prostatic capsule, prostatic urethra, and bladder neck, leading to the relaxation of the bladder and prostate and improving the flow of urine and improvement in symptoms in patients with BPH.

Indications

• Treatment of the signs and symptoms of BPH

Contraindications and cautions

• Contraindicated with allergy to any component of the product; hepatic insufficiency, pregnancy, lactation.
• Use cautiously with hypotension, renal insufficiency, prolonged QTc interval, CAD.

Available forms

ER tablets—10 mg

Dosages

ADULTS

10 mg/d PO after the same meal each day.

PEDIATRIC PATIENTS

Safety and efficacy not established.

Pharmacokinetics

Metabolism: Hepatic; T_1/2: 10 hr

Distribution: Crosses placenta; may enter breast milk

Excretion: Urine and feces

Adverse effects

• CNS: Dizziness, headache
• CV: Orthostatic hypotension, syncope, tachycardia, chest pain
• GI: Abdominal pain, dyspepsia, constipation, nausea
• GU: Impotence, priapism
• Respiratory: Cough, bronchitis, sinusitis, pharyngitis, upper respiratory tract infection
• Other: Fatigue, pain

Interactions

Drug-drug

• Increased serum levels and risk of adverse effects of alfuzosin if combined with CYP3A4 inhibitors, ketoconazole, itraconazole, ritonavir; use of these combinations is contraindicated
• Increased risk of orthostatic hypotension and syncope if combined with antihypertensive medications; monitor patient closely and adjust antihypertensive dosage accordingly
• Increased risk of adverse effects if combined with other adrenergic blockers; monitor patients closely and adjust dosages as needed

Nursing considerations

Assessment

• History: Allergy to alfuzosin, hepatic or renal dysfunction, CAD, prolonged QTc interval, pregnancy, lactation
• Physical: Body weight; skin color, lesions; orientation, affect, reflexes; P, BP, orthostatic BP; R, adventitious sounds; PSA level; voiding pattern, normal output, urinalysis

Interventions

• Ensure that patient does not have prostatic cancer before beginning treatment; check for normal PSA levels.
• Administer once a day, after the same meal each day.
• Ensure that patient does not crush, chew, or cut tablet. Tablet should be swallowed whole.
• Store tablets in a dry place, protected from light.
• WARNING: Monitor patient carefully for orthostatic hypotension; chance of orthostatic hypotension, dizziness, and syncope are greatest with the first dose. Establish safety precautions as appropriate.

Teaching points

• Take this drug exactly as prescribed, once a day. Do not chew, crush, or cut tablets; tablets must be swallowed whole. Use care when beginning therapy; dizziness and syncope are most likely at the beginning of therapy. Change position slowly to avoid increased dizziness. Take the drug after the same meal each day. Do not take the drug on an empty stomach.
• You may experience these side effects: Dizziness, weakness (these are more likely to occur when you change position, in the early morning, after exercise, in hot weather, and when you have consumed alcohol; some tolerance may occur after you have taken the drug for a while. Avoid driving a car or engaging in tasks that require alertness while you are experiencing these symptoms; remember to change position slowly, use caution when climbing stairs, lie down for a while if dizziness persists); GI upset (eat frequent small meals); impotence (you may wish to discuss this with your health care provider); fatigue.
• Report frequent dizziness or fainting, worsening of symptoms, chest pain.