Urology Case No 6. Over Active Bladder.

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Urology Case No 6. Over Active Bladder.

নাহিদ, বয়স ২৭.

ডাক্তারের কাছে আসছে, সমস্যা হচ্ছে কিছুক্ষণ পরপর প্রস্রাব করতে হয়, প্রস্রাব ধরে রাখতে পারেনা, প্রস্রাবের বেগ হলেই প্রস্রাব করা লাগে. জোরি কাশি দিলে প্রস্রাব বেরিয়ে যায়, রাতে কয়েকবার প্রস্রাব করতে ঘুম থেকে উঠা লাগে।

ডাক্তার জিজ্ঞাস করলেন,,, আপনার কি প্রস্রাব শুরু করতে কোনো কষ্ট হয়? রোগীর উত্তর না… কোনো কষ্ট হয়না

প্রস্রাব করার সময় মাঝেমধ্যে প্রস্রাব থেমে যায়?

উত্তর- না

প্রস্রাব এর ফ্লো টা কি আপনার কাছে স্বাভাবিক এর চেয়ে কম মনে হয়? উত্তর- না, ফ্লো স্বাভাবিক ই আছে, আমার মূল সমস্যা প্রস্রাবে ঘন ঘন যাওয়া লাগে,

প্রস্রাব করতে অনেক সময় লাগে?। উত্তর- না

এবার আপনি উপরের সিনারিও থেকে ডায়াগনোসিস করেন..

তার সমস্যা কি?৷ OAB নাকি BPE?

আসুন, জেনে নিই, OAB তে কি হয়?

OAB = Over active bladder

ব্লাডার এর muscle সমূহ এই ক্ষেত্রে involuntarily contraction হতে থাকে, (এই নিয়ে বিস্তারিত আগে লেখা হয়েছে-)

ব্লাডারের প্রস্রাব জমা রাখা, যদি ব্লাডার অনিয়ন্ত্রিত এবং অনিয়মিত সংকুচিত হয় তাহলে কি হবে??

১– bladder contraction এর সময় ইউরিন এর বেগ হবে ৷ Urinary Urgency, তথা হঠাৎ ইউরিন এর বেগ হবে।

২। হঠাৎ হঠাৎ ইউরিন এর বেগ হবার কারণে ঘনঘন প্রস্রাব হবে.. Urinary frequency

৩… রাতেও প্রস্রাব হবে কয়েকবার ( Nocturia)

যেহেতু এখানে মূল সমস্যা ব্লাডার এর over activity.

এখানে মূত্র বাহির হবার পথে কোনো সমস্যা নাই,

যেহেতু Urethra বা মূত্রনালীতে কোনো সমস্যা নাই,

তাহলে প্রস্রাব ঘনঘন হবে ঠিকই তবে প্রস্রাব শুরু করতে কোনো পেইন হবেনা,প্রস্রাবের ফ্লো ঠিক থাকবে,

প্রস্রাব করতে কোনো বল প্রয়োগের দরকার হবেনা

প্রস্রাব মাঝেমাঝে আটকে যাবেনা… তাহলে এই ক্রাইটেরিয়া গুলি দিয়ে আমরা ওভার এক্টিভ ব্লাডার ডায়াগনোসিস করবো, সাথে সাথে BPE exclude করতে পারবো-

BPE তে সাধারণত Prostate gland সাইজ বড় হয়ে যায়, এবং মূত্র নালীর উপর চাপ দেয়-

মনে করুন, একটা স্যালাইন সেট দিয়ে ফ্লুইড আসতেছে, এখন যদি আপনি সেই স্যালাইন সেটের পাইপের উপর এক কেজি ওজনের একটা কিছু দিয়ে চাপ দেন, তাহলে কি হবে?

স্যালাইনের ফ্লো কমে যাবে, ঠিক একইভাবে

ইউরেথ্রার উপরে যদি prsotate gland চাপ দেয়, তখন প্রস্রাবের বেগ হয়, তবে যেহেতু প্রস্রাব বের হবার নালির উপর প্রস্টেট দিয়ে প্রেশার পড়তেছে, তাই প্রস্রাব শুরু করতে কষ্ট হবে ( inability to start urination) যাকে ইউরিনারি হেসিটেন্সি বলে,৷ আবার কষ্ট করে প্রস্রাব শুরু হলেও যেহেতু রাস্তা ক্লিয়ার নাই, তাই ফ্লো কম হবে,(poor streaming)

আবার প্রস্রাব চলা অবস্থায় মাঝেমাঝে বন্ধ হয়ে যাবে,

অনেক সময় লাগবে প্রস্রাব ক্লিয়ার করতে (urinary prolongation), আবার মাঝেমধ্যে এক দুই ফোটা করে বের হতে পারে,এই ফিচার গুলি কেবল obstruction এর কারণেই হতে পারে, তথা BPE ইত্যাদির কারণে হয়ে থাকতে পারে,

OAB or BPE, উভয় ক্ষেত্রেই সর্ব প্রথম Urine RME করে UTI exclude করবে,কারণ ইউরিন ইনফেকশন হলেও উপরের উপসর্গ গুলি দেখা যায়।

আর যদি এমন জায়গায় আছেন, যেখানে টেস্ট এভেইলবল না, সেখানে আরো কিছু হিস্ট্রি নিবেন, যথা জ্বর আছে কিনা? প্রস্রাবে জ্বালাপোড়া আছে কিনা? জ্বর ও জালাপোড়া থাকলে UTI

এবার আসুন, symptoms শুনে BPE মনে হলে USG দিবেন,

আর over active bladder হলেও UTI এবং BPE Exclude করে চিকিৎসা দিবেন,

উপরে জাহিদের সিনারিও তে যেই সমস্যা গুলি রয়েছে.

জাহিদের কিছুক্ষণ পর পর প্রস্রাব করা লাগে, (Urinary frequency) রাতে ঘুম থেকে জেগে উঠে প্রস্রাব করা লাগে,

(Nocturia) প্রস্রাব ধরে রাখতে পারেনা (Urge incontinence). তবে জাহিদের poor streaming বা hesitency নাই, hesitency poor_streaming

prolong urination এই তিনটা উপসর্গ BPE এর ক্লিনিক্যাল ডায়াগনস্টিক ক্রাইটেরিয়া।

আর Frequency, urgency, without hesitency and poor streaming, Dx criteria for OAB-

Over active bladder এর জন্য

Anti-cholinergic drugs দেওয়া হয়, সাথে Antidepressant .

BEP এর জন্য আলপা ব্লকার দেওয়া হয়।

Rx for OAB—Treatment Management:- (Solifenacin)

Tablet 1: Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

1+0+0 (6-8 weeks)

Indications of Tablet : Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

Utrobin is indicated for symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency as may occur in patients with overactive bladder syndrome.

Pharmacology of Tablet : Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

Solifenacin is a competitive muscarinic receptor antagonist. It has the highest affinity for M3, M1, and M2 muscarinic receptors. 80% of the muscarinic receptors in the bladder are M2, while 20% are M3. Solifenacin’s antagonism of the M3 receptor prevents contraction of the detrusor muscle, while antagonism of the M2 receptor may prevent contraction of smooth muscle in the bladder.

Dosage & Administration of Tablet : Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

The recommended dose for adults and the elderly: Solifenacin Succinate 5 mg once daily. If needed, the dose may be increased to Solifenacin Succinate 10 mg once daily.

Use in children: Safety and effectiveness in children have not yet been established. Therefore, Solifenacin Succinate should not be used in children.

Contraindications of Tablet : Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

Solifenacin is contraindicated in patients with hypersensitivity to solifenacin or to any of the excipients. It is also contraindicated in myasthenia gravis, urinary retention, uncontrolled narrow angle glaucoma, severe gastro-intestinal condition (including toxic megacolon), patients undergoing haemodialysis, patients with severe hepatic impairment, patients with severe renal impairment or moderate hepatic impairment and on treatment with a strong CYP3A4 inhibitor, e.g. ketoconazole.

Side Effects of Tablet : Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

Due to the pharmacological effect of Utrobin, it may cause anticholinergic undesirable effects of (in general) mild or moderate severity. The frequency of anticholinergic undesirable effects is dose related. The most commonly reported adverse reactionwith Utrobin is dry mouth. It occurred in 11% of patients treated with 5 mg once daily, in 22% of patients treated with 10 mg once daily and in 4% of placebo-treated patients. The severity of dry mouth was generally mild and only occasionally led to discontinuation of treatment. In general,medicinal product compliance was very high (approximately 99%) and approximately 90% of the patients treated with Utrobin completed the full study period of 12 weeks treatment.

Gastrointestinal disorders: very common- dry mouth, common-constipation, nausea, dyspepsia, abdominal pain, uncommon- gastroesophageal reflux diseases, dry throat, rare- colonic obstruction, faecal impaction, very rare- vomiting.
Infections and infestations: uncommonurinary tract infection, cystitis.
nervous system disorders: uncommon- somnolence, dysgeusia, very rare-dizziness, headache.
psychiatric disorders: very rare- hallucinations.
eye disorders: common- blurred vision, uncommon- dry eyes.
General disorders and administration site conditions: uncommon- fatigue, peripheral oedema.
Respiratory, thoracic and mediastinal disorders: uncommon nasal dryness.
skin and subcutaneous tissue disorders: uncommon- dry skin, very rare- pruritus, rash, urticaria.
renal and urinary disorders: uncommon- difficulty in micturition, rare- urinary retention.

Pregnancy & Lactation of Tablet : Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

No clinical data are available from women who became pregnant while taking Solifenacin. Animal studies do not indicate direct harmful effects on fertility, embryonal / foetal development or parturition. The potential risk for humans is unknown. Caution should be exercised when prescribing to pregnant women. No data on the excretion of Solifenacin in human milk are available. In mice, Solifenacin and/or its metabolites was excreted in milk, and caused a dose dependent failure to thrive in neonatal mice. The use of Solifenacin should therefore be avoided during breast-feeding.

Therapeutic Class of Tablet : Utrobin 5 mg AS A Solifenacin Succinate AS A Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.

Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence

এইটার অল্টারনেটিভ হিসাবে দিতে পারেন-

Darifenacin (Darifen ER 7.5 mg)

Tablet 2:- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

Indications of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

Darifen ER is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency and frequency.

Pharmacology of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

Darifenacin is a potent, competitive and selective muscarinic receptor antagonist which has greater binding affinity for muscarinic M3 receptors. M3 receptors are involved in the contraction of the detrusor muscle of the bladder, GI smooth muscle, saliva production, and iris sphincter function. Darifenacin may increase volume threshold in patients with involuntary detrusor contraction, thus increase bladder capacity.

Dosage & Administration of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

Darifenacin 7.5 mg once daily; may increase dose to 15 mg once daily if no adequate response after 2 wk of therapy. Darifenacin should be taken with liquid. It can be taken with or without food, and should be swallowed whole and not chewed, divided or crushed.

For patients with moderate hepatic impairment or when co-administered with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir, nelfinavir, clarithromycin and nefazadone), the daily dose of Darifenacin should not exceed 7.5 mg.

Interaction of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

Darifen ER has known drug-drug interaction with CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, ritonavir, nelfinavir etc.). The concomitant use of Darifen ER with other anticholinergic agents may increase the frequency and/or severity of dry mouth, constipation, blurred vision and other anticholinergic pharmacological effects.

Contraindications of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

Patient with urinary retention, gastric retention, uncontrolled narrow-angle glaucoma, and in patients who are at risk for these conditions.

Side Effects of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

The most common side effects are dry mouth & constipation. Other less commonly reported side effects include- abnormal vision, back pain, dry skin, hypertension, vomiting, peripheral edema, weight gain, arthralgia, bronchitis, pharyngitis, rhinitis, sinusitis, rash, pruritus, urinary tract disorder and vaginitis.

Pregnancy & Lactation of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

Pregnancy Category C. Darifenacin should be used during pregnancy only if the benefit to the mother outweighs the potential risk to the fetus.

Lactation: It is not known whether Darifenacin is excreted into human milk and therefore caution should be exercised before Darifenacin is administered to a nursing woman.

Therapeutic Class of Tablet :- Darifen ER 7.5 mg (AS A Darifenacin AS a BPH/ Urinary retention/ Urinary incontinence).

BPH/ Urinary retention/ Urinary incontinence

OR Telterodin (Ucol 2mg)

Tablet 3.Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

Indications of Tablet:-Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

Ucol is indicated for the treatment of an overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency.

Pharmacology of Tablet:-Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

Tolterodine is a competitive, specific muscarinic receptor antagonist which exhibits a selectivity for the urinary bladder over salivary glands, which have been demonstrated in non clinical pharmacological in vivo studies. Tolterodine has a high specificity for muscarinic receptors. A major active metabolite (5-hydroxymethyl derivative) of tolterodine exhibits a pharmacological profile which is similar to that of the parent compound. In extensive metabolisers this metabolite contributes significantly to the therapeutic effect of tolterodine. The effect of treatment can be expected within 4 weeks.

Dosage & Administration of Tablet:-Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

Extended-release capsule: The recommended dose is Tolterodine Tartrate 4 mg once daily. The dose may be lowered to 2 mg once daily based on individual response and tolerability. For patients with significantly reduced hepatic or renal function or who are currently taking drugs that are potent inhibitors of CYP3A4, the recommended dose is Tolterodine Tartrate 2 mg daily.

Film-coated tablet: The recommended dose is Tolterodine Tartrate 2 mg twice daily except in patients with impaired liver function or severely impaired renal function (GFR<30 ml/min) for whom the recommended dose is one Tolterodine Tartrate 1 mg tablet twice daily. In case of troublesome side effects, the dose may be reduced from 2 mg to 1 mg twice daily. The effect of treatment should be re-evaluated after 2-3 months.

Pediatric use: The safety and effectiveness of tolterodine in children have not been established.

Geriatric use: No overall differences in safety were observed between the older and younger patients treated with Tolterodine.

Contraindications of Tablet:-Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

Tolterodine Tartrate is contra-indicated in patients with urinary retention, gastric retention, or uncontrolled narrow-angle glaucoma, or in patients who have demonstrated hypersensitivity to Tolterodine Tartrate.

Side Effects of Tablet:-Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

The most common side effects reported by patients receiving Ucol were dry mouth, headache, constipation, and abdominal pain. Dry mouth was the most frequently reported adverse event for patients treated with Ucol tablets occurring in 23.4% of patients treated with Ucol tablets and 7.7% of placebo-treated patients. Dry mouth, constipation, abnormal vision (accommodation abnormalities), urinary retention, and dry eyes are expected side effects of antimuscarinic agents. The adverse events were reported regardless of causality.

Pregnancy & Lactation of Tablet:-Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

There are no studies of Tolterodine in pregnant women. Therefore, Tolterodine Tartrate tablets should be used during pregnancy only if the potential benefit for the mother justifies the potential risk to the fetus. It is not known whether Tolterodine is excreted in human milk. Therefore, Tolterodine Tartrate tablets should not be administered during nursing. A decision should be made whether to discontinue nursing or to discontinue Tolterodine Tartrate tablets in nursing mothers.

Therapeutic Class of Tablet:-Ucol-2mg (AS A Telterodine Tartrate AS A BPH/ Urinary retention/ Urinary incontinence).

BPH/ Urinary retention/ Urinary incontinence

Tablet 4: Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

0+0+1 ( imipramine) 4 weeks

Indications of Tablet : Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

0+0+1 ( imipramine) 4 weeks

Tofranil is indicated in-

Depressive illness
Nocturnal enuresis in children.

Pharmacology of Tablet : Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Imipramine works by inhibiting the neuronal reuptake of the neurotransmitters norepinephrine and serotonin. It binds the sodium-dependent serotonin transporter and sodium-dependent norepinephrine transporter reducing the reuptake of norepinephrine and serotonin by neurons. Depression has been linked to a lack of stimulation of the post-synaptic neuron by norepinephrine and serotonin. Slowing the reuptake of these neurotransmitters increases their concentration in the synaptic cleft, producing knock-on effects in protein kinase signaling which is thought to contribute to changes in neurotransmission and brain physiology which relieves symptoms of depression.

Dosage & Administration of Tablet : Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Depression:

Initially up to 75 mg daily in divided doses increased gradually to 150-200 mg (up to 300 mg in hospital patients)
Up to 150 mg may be given as a single dose at bedtime
Elderly initially 10 mg daily, increased gradually to 30-50 mg daily
Child not recommended for depression

Nocturnal enuresis:

Child 7-8 years: 25 mg
8-11 years: 25-50 mg
Over 11 years: 50-75 mg at bedtime; max

Period of treatment (including gradual withdrawal): 3 months-full physical examinations before the further course.

Contraindications of Tablet : Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Imipramine should not be given in conjunction with, or within 14 days of treatment with a MAO inhibitor. The combined therapy of this type could lead to the appearance of serious interactions such as hypertensive crises, hyperactivity, hyperpyrexia, spasticity, severe convulsions or coma and death may occur. Imipramine is contraindicated in patients with existing severe hepatic or renal damage, and those with a history of blood dyscrasias. Imipramine is contraindicated in patients who have shown hypersensitivity to the drug or hypersensitivity to tricyclic antidepressants belonging to the dibenzazepine group. Imipramine is contraindicated for use during the acute recovery phase following myocardial infarction. It should not be used in patients with convulsive disorders or glaucoma.

Side Effects of Tablet : Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

The most frequent of side effects are dry mouth, constipation, urinary retention, increased heart rate, sedation, irritability, dizziness, and decreased coordination. Dry mouth, if severe to the point of causing difficulty speaking or swallowing, may be managed by dosage reduction or temporary discontinuation of the drug. Tofranil usage has been linked to both increases and decreases in blood pressure and heart rate. Heart attacks, congestive heart failure, and strokes have been reported. Confusion, disorientation, delusions, insomnia, and anxiety have also been reported as side effects in a small percentage of people taking imipramine. Problems associated with the skin (loss of sensation, numbness and tingling, rashes, spots, itching and puffiness), seizures, and ringing in the ears have also been reported. Nausea, vomiting, loss of appetite, diarrhea, and abdominal cramping are all side effects associated with imipramine usage in a small number of people.

Pregnancy & Lactation of Tablet : Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Pregnancy category D. Limited data suggest that imipramine is likely to be excreted in human breast milk. Known risk of damage to fetus.

Therapeutic Class of Tablet : Tofranil 25 mg (AS A imipramine Hydrochloride AS A Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant).

Tricyclic & related anti-depressant drugs, Tricyclic Anti-depressant

Advice —

Pelvic floor muscle এক্সারসাইজ করুন। (Youtub থেকে দেখে নিবেন) এতে করে ব্লাডার ইরিটেশন কমবে,৷ over activity কমবে।

২। প্রস্রাব এর বেগ হবার সাথে সাথে দৌড় দিয়ে টয়লেটে যাবেন না, প্রস্রাব বেগ হলে সুপ্রা-পিউবিক রিজিওনে একটু হালকা ম্যাসাজ করুন, মন অন্য দিকে ডাইভার্ট করুন, অথবা জাস্ট ৫ মিনিট পরে করুন, এবং পরের দিন ৭ মিনিট পরে প্রস্রাব করবেন, এইভাবে টাইম ইন্টারভাল টা বাড়াতে থাকুন, তখন bladder er over activity কমে যাবে।

৩.. প্রস্রাবের বেগ হলে কিছুক্ষণ Deep breath নেন, এতে করে ব্লাডার রিলাক্স হবে।

৪। যেইসব খাবার খেলে Bladder over active হয়, তা পরিহার করুন। চা, কফি, মিষ্টি , টক ফল, ঝাল খাবার, অ্যালকোহল ইত্যাদি পরিহার করবে।

BEP এর চিকিৎসা —

Capsule 5: Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

0+0+1 (4 -6 weeks)

Indications of Capsule : -Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

Uromax Hydrochloride is indicated for the treatment of functional symptoms of Benign Prostatic Hyperplasia (BPH).

Pharmacology of Capsule : -Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

Tamsulosin, a selective alpha1 adrenoceptor blocking agent, exhibits its selectivity for alpha1 A adrenoceptors in human prostate. Blockade of these adrenoceptors can cause smooth muscle in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and a reduction in symptoms of BPH. Absorption of Tamsulosin hydrochloride capsule 0.4mg is essentially complete (90%) following oral administration under fasting conditions. The time to maximum concentration (Tmax) is reached by four to five hours under fasting conditions and by six to seven hours when administered with food. Tamsulosin hydrochloride is extremely bound to human plasma protein (94% to 99%). Tamsulosin hydrochloride is extensively metabolized by cytochrome P 450 enzymes in the liver and less than 10% of the dose is excreted in urine as unchanged form. Following intravenous or oral administration of an immediate-release formulation the elimination half-life of Tamsulosin hydrochloride in plasma ranges from five to seven hours. Because of the absorption rate controlled pharmacokinetics with Prostam capsules, the apparent half-life of Tamsulosin hydrochloride is approximately 9 to 13 hours in healthy volunteers and 14 to 15 hours in the target population.

Dosage & Administration of Capsule : -Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

Tamsulosin Hydrochloride 0.4 mg (one capsule) daily, to be taken after meal at night. The dose may be increased after 2 to 4 weeks, if necessary, to Tamsulosin Hydrochloride 0.8 mg (two capsules) once daily. If Tamsulosin Hydrochloride administration is discontinued or interrupted for several days at either the 0.4 mg or 0.8 mg dose, therapy should be started again with the Tamsulosin Hydrochloride 0.4 mg (one capsule) once daily dose. The capsule should be swallowed whole with a glass of water (about 150 ml) in the standing or sitting position. The capsule should not be crunched or chewed, as this will interfere with the modified release of the active ingredient.

Contraindications of Capsule : -Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

Tamsulosin hydrochloride is contraindicated in patients with hypersensitivity to it; history of orthostatic hypotension; severe hepatic insufficiency.

As with other alpha1 blockers, a reduction in blood pressure can occur in individual cases during treatment with Tamsulosin, as a result of which, rarely, syncope can occur, at the first signs of orthostatic hypotension (dizziness, weakness) the patient should sit or lie down until the symptoms have disappeared. And they should be cautioned to avoid situations where injury could result (like driving, operating machinery or performing hazardous tasks).

Before therapy with Tamsulosin is initiated the patient should be examined in order to exclude the presence of other conditions which can cause the same symptoms as Benign Prostatic hyperplasia. Digital rectal examination and when the necessary determination of Prostate Specific Antigen (PSA) should be performed before treatment and at regular intervals afterwards.

Side Effects of Capsule : -Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

The following adverse reactions have been reported during the use of Uromax: dizziness, abnormal ejaculation and; less frequently headache, asthenia, postural hypotension and palpitations.

Pregnancy & Lactation of Capsule : -Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

Use of Tamsulosin in pregnancy and lactation is not recommended.

Therapeutic Class of Capsule : -Uromax 0.4 mg (AS A Tamsulosin Hydrochloride AS A BPH/ Urinary retention/ Urinary incontinence).

BPH/ Urinary retention/ Urinary incontinence

রেস্পন্স না করলে surgical procedure..

Raiyyan Tahsan Date:21-01-2025 Tuesday Time:1-21-35 Pm

Raiyyan Tahsan

Raiyyan Tahsan