Alfuzosin, Doxazosin, Indoramin, Prazosin, Tamsulosin, Terazosin
Issues for Surgery
For treatment of hypertension – loss of blood pressure (BP) control if omitted.
For benign prostatic hyperplasia – risk of acute urinary retention if omitted.
Risk of hypotension when continued, particularly with alfuzosin (see Interaction(s) with Common Anaesthetic Agents)
Risk of Intraoperative Floppy Iris Syndrome (IFIS) in patients undergoing cataract surgery when continued (see Further Information).
Advice in the Perioperative period
Elective and Emergency Surgery
Continue, including combination product – monitor BP.
Patients undergoing Cataract Surgery
Ensure the Ophthalmologist / Cataract Surgeon is aware the patient is taking an alpha-adrenoceptor blocker (see Further Information).
Patients undergoing Transurethral Resection of Prostate (TURP)
If indicated for the treatment of Benign Prostatic Hyperplasia (BPH), alpha-adrenoceptor blockers may be stopped following an effectual TURP, subject to a successful Trial Without Catheter (TWOC).
Interaction(s) with Common Anaesthetic Agents
Alpha-adrenoceptor blockers can increase the risk of hypotension when used concomitantly with inhalational or intravenous anaesthetics1.
The manufacturer of alfuzosin advises withhold 24 hours prior to surgery2, 3. However, in practice alfuzosin is continued – monitor BP.
Interaction(s) with other Common Medicines used in the Perioperative Period
Alpha-adrenoceptor blockers can increase the risk of hypotension when used concomitantly with droperidol or prochlorperazine1.
Intraoperative Floppy Iris Syndrome (IFIS)
IFIS has been observed during cataract surgery in some patients on or previously treated with tamsulosin. Isolated reports have also been received with other alpha-adrenoceptor blockers and the possibility of a class effect cannot be excluded. As IFIS may lead to increased procedural complications during the cataract operation current or past use of alpha-adrenoceptor blockers should be made known to the Ophthalmic Surgeon in advance of surgery1, 3, 4, 5, 6, 7, 8.