Flomax Side Effects Lead to Call for Cataract Surgery Screening

Following a recent study that linked Flomax to cataract surgery complications, an eye surgeon is calling for doctors to have their patients screened by an ophthalmologist before starting treatment with the urinary drug or similar medications.

Flomax (tamsulosin) is an elective medication used to treat urinary problems in men with enlarged prostates, which reduces difficulties like frequent urination, urgent need to urinate and waking up during the night.

A study published last week in the Journal of the American Medical Association (JAMA) indicates that Flomax side effects may double the risk of older men developing serious eye complications after cataract surgery, known as Intraoperative Floppy Iris Syndrome (IFIS). This can lead to retinal detachment, iris prolapse and other serious eye problems.

According to a letter to the editor in this month’s issue of Eyenet, published by the American Academy of Ophthalmology, Dr. Cary M. Silverman, Medical Director of Eyecare 20/20 in East Hanover, New Jersey, indicates that urologists should have their patients screened by an ophthalmologist for cataract surgery, so that they can have any necessary surgery before being placed on Flomax.

“If the urologist is considering starting a patient on an alpha blocker to treat urinary symptoms, a baseline exam from the ophthalmologist should be considered prior to treatment,” Dr. Silverman wrote. “If a cataract is detected, it might make sense to treat the cataract prior to the initiation of alpha blocker therapy.”

Dr. Silverman has started a petition among ophthalmologists aimed at making his suggestion a standard medical practice.

Cataract surgery is the most common surgery performed in the United States, with about 2 million surgeries every year, especially among older individuals.

Flomax, which is manufactured by Boehringer Ingelheim, is a widely used medication among older men, with nearly three quarters of men being effected by an enlarged prostate by age 70. In 2008, Flomax generated sales in excess of $1 billion.

The JAMA study looked at nearly 100,000 men over 65 years old, and found that 7.5 percent of those taking Flomax during the 14 days before cataract surgery developed Interoperative Floppy Iris Syndrome (IFIS), compared to less than 3 percent of men who did not use the medication. While the Flomax cataract surgery complications were most severe when the drug was used two weeks before cataract surgery, the study suggests Flomax can cause problems even when patients have ceased using it up to a year before surgery.

Dr. Silverman is not the first medical professional to call for action after the study’s publication. In an editorial that accompanied the article in The Journal of the American Medical Association, Dr. Alan H. Friedman, from the Departments of Ophthalmology and Pathology at Mount Sinai School of Medicine in New York, suggested that a more stringent warning label for Flomax was needed.

Currently, Flomax warnings only include a general precaution about the possibility of IFIS. Dr. Friedman indicated that the data on the risk of the Flomax eye complications should be re-examined to determine whether a “black box” warning is necessary to warn ophthalmic surgeons and the public about taking the medication before cataract surgery.