alfuzosin hydrochloride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
alfuzosin hydrochloride: clinical details
Prescribing considerations
- Assess postural-hypotension risk, particularly in older people and those taking antihypertensives or nitrates.
- Review cardiac history, QT-prolonging medicines and potent CYP3A4 inhibitors.
- Use caution in acute cardiac failure or after a pronounced hypotensive response to another alpha-blocker.
- Do not use the selected prolonged-release products in severe renal impairment because clinical safety data are unavailable.
- Ensure ophthalmology teams know about current or previous alpha-blocker exposure before cataract surgery.
- Reassess worsening or recurrent angina and suspected hepatic or haematological adverse effects.
Contraindications and cautions
- Hypersensitivity to alfuzosin or a formulation excipient
- History of orthostatic hypotension
- Concurrent alpha-1 receptor blocker
- Specified ritonavir-containing combinations
- Hepatic insufficiency
Monitoring
- Blood pressure, including postural symptoms, particularly after initiation and when antihypertensive or nitrate treatment is present
- Clinical response and urinary symptoms
- Angina symptoms and cardiovascular tolerability
- QT risk before and during treatment where relevant
- Symptoms suggesting liver injury, thrombocytopenia or neutropenia
Clinical pharmacology
Alfuzosin is a peripherally acting quinazoline alpha-1 antagonist. The prolonged-release formulation is absorbed more consistently with food, is highly protein bound and is extensively hepatically metabolised, mainly through CYP3A4; inactive metabolites are predominantly excreted in faeces.
Formulation and product differences
- Both selected products are prolonged-release tablets that must be swallowed whole and taken after a meal.
- Zochek is a white to off-white film-coated tablet marked X and 47.
- Besavar XL is a round three-layer tablet with a white layer between two yellow layers.
- Besavar XL contains hydrogenated castor oil, which may cause stomach upset or diarrhoea; excipients otherwise differ between products.
alfuzosin hydrochloride preparations and strengths
Modified-release tablet
Route: Oral
Strengths: 10 mg
Tablet
Route: Oral
Strengths: 2.5 mg, 10 mg
alfuzosin hydrochloride interactions
A medication review is important before alfuzosin is started or when another treatment is added.
Other alpha-1 blockers
The combination is contraindicated because effects such as low blood pressure may be increased.
Ritonavir-containing treatments, including nirmatrelvir with ritonavir
Selected products contraindicate these combinations because alfuzosin exposure can become dangerously high.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.