Alpha-blockers are medicines that are mainly used to treat hypertension (high blood pressure), and problems with passing urine in men who have enlargement of the prostate gland. If you have hypertension - alpha-blockers are usually prescribed after most other medicines have been tried. If you have problems passing urine (because of an enlarged prostate), the decision to start alpha-blockers depends on how much you are bothered by the symptoms. Side-effects are uncommon (slight drowsiness, headaches, and dizziness). They are more likely to occur in the first two weeks of treatment, and usually go away on their own.
What are alpha-blockers?
Alpha-blockers are medicines that are mainly used to treat hypertension (high blood pressure), and problems with passing urine in men who have enlargement of the prostate gland. Prostate gland enlargement is also called benign prostatic hyperplasia (BPH). An enlarged prostate can cause problems with passing urine, such as having to wait before your urine starts to flow, taking longer at the toilet, dribbling, and a feeling that your bladder is not quite empty. In the past, some alpha-blockers were also used to treat heart failure and Raynaud's phenomenon. However, they are very rarely used to treat these conditions now because there are other medicines that are thought to work better for these conditions.
There are six alpha-blockers available to prescribe in the UK. They are: alfuzosin, doxazosin, indoramin, prazosin, tamsulosin, and terazosin. Alpha-blockers come as tablets or capsules which may be taken once a day or up to three times a day. They come in various brand names.
The rest of this leaflet only discusses the use of alpha-blockers when they are used to treat hypertension or the symptoms of prostate gland enlargement. There is also more general information in separate leaflets called Hypertension and Prostate Gland Enlargement.
How do alpha-blockers work?
Alpha-blockers work by blocking the transmission of certain nerve impulses. The ends of some nerves release a chemical (neurotransmitter) called noradrenaline when the nerve is stimulated. This chemical then stimulates alpha-adrenergic receptors. These receptors are tiny structures which occur on cells in various parts of the body including the heart, smooth muscle, and blood vessels. When these receptors are stimulated, they cause various effects.
The alpha-blocker medicine attaches to alpha-adrenergic receptors and so stops (blocks) the receptor from being stimulated. This can have various effects in the body which include:
- For hypertension: alpha blockers work by relaxing blood vessels. This allows blood and oxygen to circulate more freely around your body, lowering blood pressure and reducing strain on your heart.
- For prostate gland enlargement: alpha-blockers work by relaxing the muscles around your bladder and prostate so that you can pass urine more easily.
When are alpha-blockers usually prescribed?
For hypertension: alpha-blockers are usually prescribed after most other medicines have been tried. Alpha-blockers are normally only started by doctors who specialise in treating hypertension and only if:
- Other medicines such as beta-blockers, angiotensin-converting enzyme (ACE) inhibitors or diuretics (water tablets) are not working. They may be used as well as these other medicines.
- There is a reason you cannot take a beta-blocker, an ACE inhibitor, or a diuretic.
Having hypertension increases your risk of having a heart attack, a stroke, diabetes, or heart failure. There are more studies which show that medicines such as beta-blockers, ACE inhibitors, and diuretics are better than alpha-blockers at lowering the risk of having these conditions.
For prostate gland enlargement: the decision to start alpha-blockers depends on how much you are bothered by the symptoms. For example, you may be glad for some treatment if you are woken six times a night, every night, with an urgent need to go to the toilet. On the other hand, slight hesitancy when you go to the toilet, and getting up once a night to pass urine may cause little problem and not need treatment. Your doctor will help you decide if this treatment is right for you.
Which alpha-blocker is usually prescribed?
For hypertension: once-daily preparations of doxazosin or terazosin are usually recommended. Once-daily preparations are generally thought to be easier for people to take and to remember to take. Prazosin and indoramin need to be taken two or three times each day, and prazosin is more likely to cause a large drop in blood pressure after taking the first dose.
For prostate gland enlargement: once-daily preparations of alfuzosin, doxazosin, tamsulosin, or terazosin are generally recommended. This is because once-daily preparations cause fewer side-effects than the preparations that need to be taken up to three times a day.
How well/quickly do alpha-blockers work?
For hypertension: there are very few studies that have looked at how well alpha-blockers work in people with hypertension. However, they have been used for many years to treat this condition.
For prostate gland enlargement: in most cases, symptoms improve with taking an alpha-blocker, but the amount of improvement varies from person to person. Some improvement usually occurs within a few days, but the full effect may take up to six weeks. Alpha-blockers do not cure the problem, nor do they usually make symptoms go completely. However, symptoms often ease if you take a medicine. There is no real difference between how effective each of the alpha-blockers are. However, some tend to cause side-effects more often than others.
What is the usual length of treatment?
Most people with hypertension need to take medication for life. However, in some people whose blood pressure has been well-controlled for three years or more, medication may be able to be stopped. In particular, in people who have made significant changes to lifestyle (such as having lost a lot of weight, or having stopped heavy drinking, etc). Your doctor can advise you.
For people with symptoms caused by prostate gland enlargement, alpha-blockers are also usually taken long-term. Your doctor will usually review your symptoms every 4-6 weeks after you start treatment. Once your symptoms have settled down, your treatment is usually reviewed every year. This is to make sure it is still working.
Taking other medicines
There are a number of medicines that should usually be avoided if you also take an alpha-blocker. These include:
- Phosphodiesterase-5 inhibitors - for example, sildenafil (trade name Viagra®).
- Antidepressants such as tricyclic antidepressants (for example, amitriptyline), mirtazapine, or venlafaxine.
When these medicines are combined with an alpha-blocker, you may get postural hypotension (a sudden drop in blood pressure).
What about side-effects?
Although side-effects are uncommon, they occur in some people. Side-effects are more likely to occur in the first two weeks of treatment, and usually go away on their own. The most common side-effects are slight drowsiness, headaches and dizziness. If you are prescribed an alpha-blocker, read the leaflet that comes with the medicine packet for a full list of possible side-effects and cautions.
Can I buy alpha-blockers?
You cannot buy alpha-blockers. They are only available from your chemist, with a doctor's prescription.
Who cannot take alpha-blockers?
Most people are able to take an alpha-blocker. However, they are usually not prescribed to people who have had postural hypotension and micturition syncope (fainting while urinating).
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- Information about the person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.
Further reading & references
- The management of lower urinary tract symptoms in men; NICE Clinical Guideline (May 2010)
- LUTS in men, age-related (prostatism); NICE CKS, August 2010
- British National Formulary
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Mrs Jenny Whitehall
Dr Tim Kenny