00:00Hi everyone, today in this video let us
discuss tamsulosin versus finasteride.
00:07What are the similarities and differences between
these two drugs we will discuss in this video.
00:14Tamsulosin is available under the brand name
Flomax, it is available as its salt tamsulosin
00:21hydrochloride, on the other hand finasteride
is available under the brand name proscar,
00:28both of these drugs both tamsulosin
hydrochloride and finasteride can
00:33be used in one of the condition benign
prostatic hyperplasia, commonly known as BPH.
00:40This condition is observed in the men with age
greater than 50 years, with the progression of
00:46the age, prostate enlargement can be observed
resulting in benign prostatic hyperplasia
00:52that leads to the development of lower urinary
tract symptoms. So in such patients we can
00:57observe increased frequency to urinate, increase
urinary agency but at the same time urinary flow
01:05is going to be reduced resulting in weak stream
of urine. So these symptoms can be reduced by
01:12both tamsulosin as well as finasteride
but the dosage is somewhat different,
01:18flomax is available as a capsule at two different
strengths such as 0.4 mg and 0.8 mg. But the
01:25proscar is available as a tablet at a strength of
5mg, even both of these drugs are indicated for
01:31the treatment of BPH there are few similarities
and differences between these two drugs, in few
01:38of the situations tamsulosin is beneficial but in
other conditions finasteride works more better,
01:45so today in this video we are going to see what
are the various similarities and differences
01:49between tamsulosin and finasteride and in
which condition these drugs are preferred
01:54we will discuss in this video. So the first one
is the increase in urinary flow, tamsulosin is
02:00one of the alpha-1A blocker, this drug acts on the
bladder where alpha 1A receptors are expressed at
02:07different locations. On the bladder neck, they are
expressed as well as they are also expressed on
02:14urethral smooth muscle attached to the prostate.
When these alpha 1A receptors are activated
02:18they produce the contraction of the smooth muscle
particularly at the bladder neck they produce the
02:23contraction resulting in the increased pressure
leading to increased frequency of urination in the
02:29patients. Similarly these alpha 1A receptors
are responsible for constriction of urethral
02:35pathway resulting in the decreased urinary
flow. Now tamsulosin is a alpha 1 A blocker,
02:40it can block this Alpha 1A receptors
resulting in the relaxation of smooth muscle
02:46which reduce the urinary frequency as well
as it can increase the urinary flow. That's
02:51why tamsulosin is well known by its brand name
Flomax because it increases the urinary flow. Now
02:57finasteride acts in a different way, finasteride
is a 5-alpha reductase inhibitor .This drug is
03:03also indicated for BPH which is associated with
prostate enlargement. Now because of increased
03:10prostate size it can produce some pressure on
the bladder so that urinary urgency increases
03:16but at the same time because of increased prostate
size, the urethral flow is also blocked resulting
03:24in decreased urinary flow in such patients. So
this results in urinary retention and sometimes
03:31it requires surgery in order to restore the
urinary flow. In those patients finasteride can
03:37be given to reduce urinary retention as well as to
prolong the time required for surgical procedure
03:46so finasteride can act on the prostate gland
thereby can reduce the prostate size which
03:53increases the urinary flow. Now both tamsulosin as
well as finasteride can increase the urinary flow
03:59but they work in different way. Tamsulosin produce
the relaxation of the bladder smooth muscle
04:06whereas finasteride reduces the prostate
size. Even though both of these drugs are
04:11going to increase the urinary flow but
the tamsulosin is having the more effect
04:15on increase the urinary flow compared with
finasteride. That's why tamsulosin is used
04:21as the first line drug in the initial stage of
BPH because this drug can increase the urinary
04:28flow significantly thereby can reduce lower
urinary tract symptoms associated with BPH.
04:36Second one is the prostate size and volume.
Normally the prostate size can be measured by
04:41one of the factor total prostate volume commonly
known as TPV, in the normal healthy people the
04:49TPV will be less than 25 cc but in the men with
BPH the total prostate volume may be increased
04:57which is associated with few of the symptoms
such as increased urinary frequency and
05:02urgency along with decreased urinary volume.
In such conditions, tamsulosin can be used to
05:08relieve the symptoms where it increase the urinary
flow but with progression of age as well as with
05:14progression of BPH the total prostate volume may
be increased so that it is greater than 30 cc.
05:21So when the TPV value is greater than 30
cc it indicates the prostate enlargement
05:27but sometimes this total prostate volume may
be greater than 40 cc, in such conditions the
05:32monotherapy of tamsulosin is somewhat ineffective.
So when the TPV is greater than 30 to 40 cubic
05:41centimeters, then tamsulosin should be combined
with other drugs which reduce the prostate size.
05:47For instance, tamsulosin can be combined with
dutasteride which is again another five Alpha
05:54reductase inhibitor. But in the patients with
prostate enlargement, finasteride can be given
05:59because it reduces the prostate size and it can
be given as a monotherapy in order to reduce the
06:05urinary retention. Third one is a type of clinical
indication. Already we have seen that tamsulosin
06:11can be used for the treatment of BPH, it is given
at an initial dose of 0.4 mg. On the other hand
06:18finasteride can be used in two conditions and it
is available under two brand names, the first one
06:24is the proscar and second one is Propecia . Under
the brand name proscar, finasteride can be used
06:30for the treatment of BPH where it is available as
5 mg tablet, whereas under the brand name Propecia
06:37finasteride can be used for the treatment of
male pattern hair loss and it is available
06:44at a dose of 1 mg. So low dose of finasteride
can be used for the management of male pattern
06:51hair loss. This is another difference between
the tamsulosin and finasteride, finasteride is
06:57having two clinical uses it can be used for both
BPH as well as for the treatment of hair loss,
07:03where it is given at a low dose. Fourth one is
the time of administration. We have seen that
07:09tamsulosin can be used to relieve the symptoms
in the BPH and it is one of the first line drug
07:13in the initial treatment of BPH. This drug is
given 30 minutes after first meal of each day,
07:21in order to reduce any adverse effects it is
always given along with the meal particularly it
07:27is given at the first meal of the day just after
30 minutes, as when this drug is given along with
07:33food it can reduce any adverse effects associated
with this drug. But when this drug is given under
07:39fasting conditions, the absorption of tamsulosin
is significantly increased which increases the
07:45toxic effects resulting in significant dizziness,
hypotension in the patients that's why this drug
07:52should not be given under fasting conditions,
it should be given 30 minutes after first meal
07:58of each day, On the other hand, finasteride
can be given either with food or without food
08:03because food is not having any significant
effect on bioavailability of finasteride.
08:09So this is another important difference
between the tamsulosin and finasteride,
08:13the intake of tamsulosin should be regular and
it is associated with the first meal of the
08:20each day. Fifth one is the pregnancy, both of
these drugs tamsulosin as well as finasteride,
08:26they are indicated only in the
men for the treatment of BPH,
08:30they are not indicated in the women as well as in
the pregnant woman they are contraindicated but
08:36the handling of finasteride is somewhat important
because when this tablet is going to be broken it
08:40is in contact with the pregnant woman there may be
a chance of accidental consumption where the drug
08:46is absorbed into the fetus resulting in some toxic
effect to the male fetus. That's why finasteride
08:53should be safely handled with the pregnant woman
in order to prevent any toxic effects on the male
09:00fetus as it produces some abnormal development of
male genitalia so finasteride should be carefully
09:07handled by pregnant women. That precaution is
not observed with tamsulosin. Sixth one is the
09:13orthostatic hypotension. In the patients with any
history of orthostatic hypotension we can observe
09:19a change in the blood pressure with change in
the posture particularly on standing the blood
09:25pressure is going to be reduced resulting in
either fainting or falling so in such patients
09:30tamsulosin can increase the dizziness as well
as confusion because tamsulosin can increase
09:37the symptoms of orthostatic hypotension. So
the patients with any history of orthostatic
09:42hypotension, tamsulosin is contraindicated due
to enhanced effect of dizziness and confusion
09:47in the patients. But finasteride is not showing
any significant orthostatic hypotension that was
09:53observed with tamsulosin so this drug can be given
in such patients with any orthostatic hypotension.
09:58Seventh one is the ejaculatory problems.
Testosterone is going to be converted into
10:03dihydro testosterone by one of the enzyme five
Alpha reductase enzyme. Now finasteride is going
10:10to inhibit the activity of this enzyme thereby
it inhibits the synthesis of dihydrotestosterone
10:16,when this activation is inhibited finasteride
can produce few of the hormonal effects and it
10:22may produce some impotence in the patients as well
as loss of libido sexual desire can be reduced
10:28even it can produce erectile dysfunction leading
to ejaculation failure, all these side effects
10:34are observed with the finasteride because of its
hormonal effects. On the other hand, tamsulosin
10:40can also show some effect on ejaculation this drug
can produce one of the condition priapism which
10:46is a condition of prolonged erection of penis
for greater than 4 hours resulting in painful
10:53erection so this tamsulosin can also produce
ejaculation failure because of prolonged erection,
10:59so both of these drugs may produce some
ejaculatory problems. But being a hormonal
11:05agent finasteride produce more effect on these
ejaculatory problems that may lead to impotence,
11:10loss of libido and even it can increase the
breast tenderness, breast enlargement in the men.
11:17Next one is the drug interactions, tamsulosin
is metabolized by cytochrome p450 system.
11:23This drug can be converted into metabolites by
CYP3A4 enzyme, which is mainly responsible for
11:30the metabolism of tamsulosin similarly this
drug can also be converted into metabolites
11:34by another enzyme CYP2D6. Now any drugs acting on
these enzymes can produce drug interactions with
11:41tamsulosin, for instance Ketoconazole is one of
the strong inhibitor of CYP3A4 enzyme thereby it
11:49inhibits a metabolism of tamsulosin, this results
in increased levels of tamsulosin within the body
11:56that leads to significant lightheadedness,
dizziness, confusion, orthostatic hypotension
12:05which are more troublesome. Similarly drugs
like paroxetine can inhibit the CYP2D6 activity
12:11thereby again they increase the toxicity of
tamsulosin. On the other hand, finasteride
12:18is free of these side effects, it is having no
significant interactions at the metabolic phase
12:23so it can be safely given with other drugs
which are affecting cytochrome p450 system.
12:30Ninth one is the prostate cancer. Both tamsulosin
as well as finasteride can reduce PSA levels,
12:38prostate specific antigen levels. Normally in the
patients with any prostate cancer, the PSA levels
12:44are increased but with use of either tamsulosin
or finasteride the PSA levels are reduced which
12:51can mask the development of prostate cancer in the
patient. That's why before use of these two drugs,
12:58a screening test should be done to check any
pre-existing prostate cancer in the patients.
13:05The use of tamsulosin for long term can induce the
prostate cancer as well as with the finasteride
13:10but the risk of prostate cancer is more pronounced
with the finasteride because of anti-androgenic
13:16effects. Tenth one is the cataract surgery.
Tamsulosin is a alpha 1A blocker so it can act
13:23as a smooth muscle relaxant so it can produce a
relaxation of various smooth muscles where alpha
13:281A receptors are located, one of the location is
on the eye, tamsulosin can produce relaxation of
13:35the iris dilator muscle. This may result in the
poor pupillary dilatation and flaccid paralysis
13:41that's why tamsulosin should be carefully given in
the cataract surgery because this drug can develop
13:47one of the syndrome intra-operative floppy Iris
syndrome IFIS. So during the cataract surgery care
13:55should be taken with use of tamsulosin and special
technique should be utilized in order to prevent
14:02any development of intraoperative floppy Iris
syndrome. Sometimes tamsulosin can also increase
14:08the post-operative intraocular pressure in the
patients so this can be minimized with proper
14:14use of cholinergic agents and antihistamines to
control the intraocular pressure. On the other
14:20hand, finasteride is not showing any effect on
cataract so it can be given during the cataract
14:26surgery. So these are the various similarities
and difference between tamsulosin and finasteride,
14:31in few of the situations tamsulosin shows some
advantage, it can significantly increase the
14:37urinary flow thereby it can relieve lower urinary
tract symptoms associated with BPH. That's why
14:43tamsulosin is a first line drug in the treatment
of BPH but this drug does not affect the prostate
14:49size and it will not reduce the prostate volume
so in those patients with significant prostate
14:54enlargement where total prostate volume is
greater than 30 cc or greater than 40 cc,
15:02in such situations finasteride works better
because it reduces prostate size as well as
15:07prostate volume. Tamsulosin is contraindicated
in the patients with orthostatic hypotension
15:13and it also shows drug interactions which affect
the metabolism of tamsulosin. On the other hand,
15:19finasteride can produce impotence in the patients
as well as it can induce the erectile dysfunction,
15:25it should be carefully handled with the pregnant
woman because of teratogenic effects on male fetus
15:31so these are the various similarities and
difference between tamsulosin and finasteride.
15:35Tamsulosin should be used to relieve the
symptoms in the patients associated with BPH,
15:42finasteride should be used in those patients
with excessive prostate enlargement.
15:48So that's all about the similarities and
differences between tamsulosin and finasteride,
15:52hope you have enjoyed this video, If you like this
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