DEAR DR. ROACH: I have benign prostatic hyperplasia (BPH), and I am taking tamsulosin daily. It works and helps with my daily urination. How long should I continue to take it? Are there any related side effects? Or should I consider an eventual prostatectomy? Thank you. — A.

ANSWER: Tamsulosin is an effective treatment for most men with symptoms of an enlarged prostate. (BPH signifies noncancerous growth of the prostate gland.) It works by relaxing special muscle fibers in the prostate (“smooth muscle”), which allows the urethra — the tube that carries urine from the bladder outside of the body, going straight through the prostate — to drain the bladder faster and with less pressure.

The most common side effect of tamsulosin and similar medicines (called “alpha blockers”) is lightheadedness, especially upon standing. Newer medicines like tamsulosin and alfuzosin are less likely to have this side effects compared to older medicines like doxazosin, but it can be a problem, especially when first using it.

I tell my patients to first sit up on the bed, make sure that you are OK, stand up, make sure that you’re OK again, then walk to the bathroom. Headaches, runny or stuffy nose, and ejaculation problems are other possible side effects. If you haven’t developed these within a few weeks, you aren’t likely to.

Before having cataract surgery, any person who has ever taken an alpha blocker should tell their eye surgeon. Tamsulosin is particularly likely to cause a problem called “intraoperative floppy iris syndrome,” so the surgeon needs to be prepared just in case.

For my patients who are getting a good result with this class of medicine, I don’t recommend changing it unless it stops working or they develop side effects. Before considering prostate surgery or another prostate procedure, such as laser, steam, freezing or embolization, I often recommend a second class of medicines, the 5-alpha reductase inhibitors finasteride or dutasteride. These take longer to work but have a benefit of reducing prostate cancer risk by about 60%.

Most men have a good outcome with traditional prostate surgery or one of the newer, less-invasive techniques. However, I have had a few of my own patients and many readers tell me that their symptoms worsened after this treatment. This is why I don’t recommend surgery unless the medicines aren’t working and the symptoms are bothersome enough to consider a procedure.

DEAR DR. ROACH: In a recent column, you mentioned a class of drugs called SNRIs for pain. I know about SSRIs for depression. What are SNRIs? — D.S.

ANSWER: SSRIs, the selective serotonin reuptake inhibitors, are among the most-used drugs for mental health problems, especially mood disorders like anxiety and depression. They have usefulness in other conditions such as eating disorders, menopausal hot flashes, premature ejaculation and others.

SNRIs are serotonin-norepinephrine reuptake inhibitors; SNRIs and SSRIs are related drugs. They are also useful for anxiety and depressive disorders but are more commonly used for chronic pain than SSRIs are.

These drugs should not be used lightly. They have the potential for serious side effects, especially in combination with other drugs that work on the serotonin receptor. However, when used properly, they are safe and effective for many purposes.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved