Tamsulosin (Flomax) Side Effects and Risks in the Elderly: What Older Adults Need to Know

Benign prostatic hyperplasia (BPH) is a common condition that affects most men as they get older. And though BPH isn’t thought to lead to serious health risks, its urinary symptoms can be particularly annoying. After all, who enjoys having to get up multiple times a night to urinate, or feel like they can't empty their bladder? 

Tamsulosin (Flomax) is a medication commonly used for BPH that can alleviate these symptoms. But it does have side effects to know about. And some tamsulosin side effects may be even worse for older adults. You may have also heard that tamsulosin can raise the risk of dementia in older adults. But is this actually true?

Here we’ll review tamsulosin side effects, including those that may be more concerning in older adults.

What is tamsulosin?

Tamsulosin belongs to a class of medications called alpha-1 blockers. Examples of other alpha-1 blockers include silodosin (Rapaflo) and alfuzosin (Uroxatral).

Tamsulosin is available as a 0.4 mg capsule that’s taken by mouth once a day after a meal. The maximum dose is 0.8 mg (2 capsules) per day.

What is tamsulosin used to treat?

Tamsulosin is used to treat BPH. It works by relaxing the muscles in the prostate and bladder. This helps urine flow more easily.

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Some alpha blockers are used to treat high blood pressure because they can relax blood vessels. But, tamsulosin isn’t one of them. That’s because it primarily targets the prostate and surrounding areas. This is one of the reasons it’s also used off-label for kidney stones.

Most common tamsulosin side effects

As with most medications, tamsulosin can cause side effects. You may be more likely to experience them if you’re taking the higher dosage (0.8 mg daily) compared to the lower dosage (0.4 mg daily).

The most common tamsulosin side effects include:

• Headache

• Dizziness

• Stuffy nose

• Abnormal ejaculation

Many of these side effects should subside as your body gets used to the medication. But if they don’t improve, or if they get worse, let your healthcare provider know.

Although rare, there are also serious side effects to know about. For example, tamsulosin can cause priapism — an erection lasting over 4 hours. Priapism can cause permanent damage to your penis if left untreated. So, it’s important to get medical attention right away if this happens.

Allergic reasons are also possible after taking tamsulosin. This can include a skin rash or hives. But it can also involve more serious symptoms, like trouble breathing and swelling of the face, tongue, or throat. Call 911 or get immediate medical attention if these symptoms develop. 

Keep in mind: Tamsulosin is considered a “sulfa drug.” You still may be able to take it if you have a sulfa allergy. But it’s important to let your healthcare provider know about your allergies so they can determine if it’s right for you.

Long-term side effects of tamsulosin

Overall, tamsulosin is relatively safe to use long-term for BPH. Multiple studies have evaluated the long-term use of tamsulosin, showing that it’s safe and effective over the course of several years. Yet, some studies suggest tamsulosin may raise the risk of dementia. More on that later.

Tamsulosin side effects in the elderly

As mentioned above, tamsulosin is generally safe for long-term use. But in older men, it may stick around in the body longer compared to younger men. This has been found to be the case in men between 55 and 75 years old. 

So, it may be possible that certain side effects become more bothersome as you get older. In this case, your healthcare provider may change your dosage or switch you to a different medication.

One of the main side effect concerns in older adults is orthostatic hypotension. Orthostatic hypotension is a change of blood pressure when moving from a laying down position or sitting to standing up. It isn’t as common in alpha blockers like tamsulosin that specifically target the prostate. But it can still happen. 

It’s important to let your healthcare provider know if you’re experiencing orthostatic hypotension. That’s because it can make you feel dizzy and lead to fainting and falling over. This is particularly concerning in older adults since falling can result in serious fractures (bone breaks). 

Is tamsulosin linked to dementia in the elderly?

Recently, there have been concerns that older men taking tamsulosin may be at higher risk of developing dementia. This is largely due to findings from a 2018 study showing higher rates of dementia in people taking tamsulosin. However, a 2019 study didn’t reach the same conclusion.

It’s not clear how or why this might happen. For example, the same receptors (chemical binding sites) tamsulosin targets on the prostate are also found in the brain. But the medication can’t reach the brain easily. 

And there are other factors that might influence findings, too. For instance, it’s possible that tamsulosin may have been masking early signs of dementia that existed prior to treatment. So, more research is needed to confirm any potential dementia risk.

Are there other alternatives for older adults?

There are several other possible treatments for BPH. But not all of them work well for older adults, and some come with a greater chance of side effects. Below are two options your healthcare provider may consider:

• Silodosin. Silodosin is an alpha-1 blocker that’s highly selective for the prostate. Because of this, it may be less likely to cause dizziness and orthostatic hypotension. But it may cause more ejaculation problems.

• Fesoterodine (Toviaz). Fesoterodine is an anticholinergic medication typically used to treat overactive bladder. But it’s sometimes used off-label for BPH. It works specifically in the bladder, so it may be safer in older adults than other anticholinergic medications.

Aside from medications, there are also surgical procedures available. However, these may not be preferred or right for everyone. In some cases, tamsulosin may be the best option. If not, your healthcare provider will determine which treatment is right for you.

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Written by:

Timothy Aungst, PharmD

Timothy Aungst, PharmD, has worked in pharmacy practice for the past decade with different roles and responsibilities. He has served as an associate professor of pharmacy practice for almost a decade, a clinical pharmacist in outpatient cardiology management, and now in home healthcare.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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