Flomax for BPH – The Prescribing Cascade

61 year old male with a history of diabetes, neuropathy, BPH presents complaining of not being able to sleep well at night.  He states that he has been diagnosed with BPH and hasn’t wanted to be treated because it hasn’t been that bad.

His current meds include:

  • metformin
  • aspirin
  • gabapentin
  • Vitamin C

For his insomnia, his primary provider recommends Elavil 25mg daily, which could possibly help with his neuropathy symptoms as well as his sleep issue.

He begins taking the Elavil for a few nights but notices that he is having a much more challenging time urinating.  His BPH symptoms are indeed worsening and this is likely due to highly anticholinergic effects of the old Tri-cyclic antidepressant Elavil (amitriptyline).

At the gentleman’s follow up visit when complaining about these symptoms, he gets prescribed Flomax to help alleviate the symptoms likely worsened by the Elavil.  When using Flomax for BPH symptoms, we have to make sure that anticholinergics are not making this problem worse.  This is a classic example of the prescribing cascade.

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Written By Eric Christianson

April 1, 2015

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