Effects of Flomax on Cataract Surgery Patients

A recent article in the American Academy of Ophthalmology related the following story:

San Francisco – The most commonly prescribed prostate drug may cause complications in cataract surgery.  A recently published study examined the incidence of Intraoperative Floppy Iris Syndrome (IFIS) in cataract surgery practices.

While Flomax does not affect vision or eye health, it does blocks the dilator muscle in the iris.  Becuase the pupils need ot be dilated, during cataract surgery this can be a problem.

Following the announcement of the study, ophthalmologists were asked to track the incidence of IFIS in cataract patients on Flomax and other prostate drugs, and send reports on verified cases to the Federal Drug Administration. The FDA responded to the doctors concerns and approved a label change for the drugs that reads “The patient’s ophthalmologist should be prepared for possible modifications to their surgical technique.” The Academy has notified its members of the FDA label change regarding the Flomax/IFIS link, and recommended that they thoroughly question their male cataract patients about prostate medications prior to surgery. Other prostate drugs in this class include Hytrin, Cardura, and Uroxatral.

In addition to having a pupil that dilates poorly, a patient with IFIS will have an iris that behaves erratically during cataract surgery. It will tend to be floppy and the pupil may suddenly constrict during the middle of surgery. This increases the risk of having surgical complications. .

It is suggested that cataract surgeons inquire specifically about prior use of Flomax as IFIS can occur several years after the drug has been discontinued. 

While it is not necessary to stop the use of Flomax, patients should inform their ophthalmologist if they are taking the drug, or any type of prostate medication prior to having eye surgery.

While Flomax is an effective drug for treating the symptoms of an enlarged prostate, and patients advised by their physician to take it should certainly continue, prior to cataract surgery, these patients absolutely need to inform their eye surgeon that they are, or have taken prostate drugs.

Warning the cataract surgeon that a patient is taking Flomax allows the cataract surgeon to anticipate the need for special measures during cataract surgery. 

What is Flomax?

Flomax is used to treat benign prostatic hyperplasia (enlarged prostate).

Flomax is in a class of drugs called alpha-adrenergic blockers. Flomax causes the blood vessels (veins and arteries) to relax and expand, so that blood passes through them more easily. This effect relaxes the muscles in the prostate and bladder neck, making it easier to urinate.

Flomax may also be used for purposes as well.

What is the most important information I should know about Flomax?

  • Use caution when driving, operating machinery, or performing other hazardous activities. Flomax may cause dizziness. If you experience dizziness, avoid these activities.
  • Dizziness is most likely to occur at the start of therapy and when rising from a sitting or lying position. Use caution and rise slowly to avoid falling.
  • Use alcohol cautiously. Alcohol may increase dizziness caused by Flomax.
  • Do not crush, chew, or open the capsules. Swallow them whole.

What should I discuss with my healthcare provider before taking Flomax?

Before taking Flomax, tell your doctor if you have any other medical conditions or if you take any other medications. You may not be able to take Flomax, or you may require a dosage adjustment or special monitoring during treatment.

How should I take Flomax?

Take Flomax exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass of water.
Do not crush, chew, or open the capsules. Swallow them whole.
Flomax is usually taken once a day, approximately one-half hour after the same meal each day. Follow your doctor’s instructions.

If dizziness occurs, taking Flomax after the evening meal may be helpful.

It is important to take Flomax regularly to get the most benefit.

If treatment with Flomax is missed or stopped for several days in a row, contact your healthcare provider before restarting the medication. A lower dose may be necessary.
Your doctor may want you to have blood tests or other medical evaluations during treatment with Flomax to monitor progress and side effects.

Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose of the medication. If treatment with Flomax is missed or stopped for several days in a row, contact your healthcare provider before restarting the medication. A lower dose may be necessary.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.
Symptoms of a Flomax overdose include weakness; dizziness; fainting; a weak, fast pulse; cold, clammy skin; and, possibly, loss of consciousness or coma.

What should I avoid while taking Flomax?

Use caution when driving, operating machinery, or performing other hazardous activities. Flomax may cause dizziness. If you experience dizziness, avoid these activities.

Dizziness is most likely to occur at the start of therapy and when rising from a sitting or lying position. Use caution and rise slowly to avoid falling.

Use alcohol cautiously. Alcohol may increase dizziness caused by Flomax.

What are the possible side effects of Flomax?

If you experience any of the following serious side effects, stop taking Flomax and seek emergency medical attention or contact your doctor immediately:

  • an allergic reaction (difficulty breathing;
  • closing of the throat;
  • swelling of the lips, tongue, or face; 
  • hives);
  • a prolonged (4 hours or more) or painful erection;
    severe dizziness;
  • fainting

Other, less serious side effects may be more likely to occur. Continue to take Flomax and notify your doctor if you experience

  • mild dizziness or drowsiness,
  • weakness,
  • double vision,
  • abnormal ejaculation, or
  • changes in libido.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Flomax?

Before taking Flomax, talk to your doctor if you are taking any of the following medicines:

  • erazosin (Hytrin),
  • prazosin (Minipress),
    doxazosin (Cardura),
  • cimetidine (Tagamet, Tagamet HB), or
  • warfarin (Coumadin).

You may not be able to take Flomax, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with Flomax. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.


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