Cobicistat
Contraindicated
Database
Increased levels
Contraindicated per label
Source: Kimi deep-research + Cla
Drug reference
Alfuzosin
Selective alpha-1 adrenergic receptor antagonist · Benign Prostatic Hyperplasia (BPH) agent
Also known as Alfuzosin Hydrochloride
START
Check BP (supine and standing). Assess for cataract surgery planned—IFIS risk. Verify no hepatic impairment or CYP3A4 inhibitors. Take immediately AFTER the same meal daily.
TYPICAL MAX
10mg/day ER. No benefit from higher doses. Must be taken after food for optimal absorption and to reduce first-dose hypotension.
STOP IF
Syncope, severe hypotension (SBP <90), priapism, IFIS during cataract surgery, severe hepatic dysfunction.
WATCH
First-dose hypotension and syncope—take at bedtime initially if concerned. IFIS risk during cataract surgery—inform ophthalmologist if patient on alpha-blocker. Orthostatic BP at follow-up. Ejaculatory dysfunction may affect sexual satisfaction—counsel patients. No effect on PSA levels (unlike 5-alpha-reductase inhibitors).
CDSCO approvedSchedule HATC G04CA01
KDIGO 2024 + manufacturer label
- ONSET
- 1h · Onset ~1 hour
- PEAK
- 8h · Tmax ER ~8 hours
- t½
- 10h · t½ ~10 hours
- DURATION
- 1d · 24 hours (QD)
EXCRETION
Fecal as metabolites (~69%)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Not indicated in pregnancy; animal studies show no teratogenicity.
FDA category + note
Top interactionssee all 12 →
- CobicistatContraindicatedDatabaseKimi deep-research + Cla
- Strong Cyp3a4 InhibitorsContraindicatedDatabaseKimi deep-research + Cla
- AmiodaroneSevereDatabaseDDInter
- AmisulprideSevereDatabaseDDInter
Available in India
41 branded formulations and 29 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Selectively blocks postsynaptic alpha-1 adrenergic receptors in the prostate, bladder neck, and urethra, relaxing smooth muscle and improving urinary flow. Minimal effect on vascular alpha-1 receptors at therapeutic doses (reduced orthostatic hypotension compared to non-selective agents).
Indications
Benign prostatic hyperplasia (BPH) / lower urinary tract symptoms (LUTS)
Dosing
- Adult
- 10mg ER PO daily immediately after the same meal each day. Do NOT crush, chew, or split ER tablets.
- Pediatric
- Not indicated in children.
- Renal adjustment
- CrCl ≥30: no adjustment. CrCl <30: use caution; limited data.
- Hepatic adjustment
- Mild (Child-Pugh A): use caution. Moderate-severe: contraindicated.
- Geriatric
- No specific adjustment; increased risk of hypotension and syncope.
- Max dose
- 10mg/day
Pharmacokinetics
Onset
Symptom improvement within days; maximal effect 4-6 weeks
Peak effect
Tmax 8 hours (ER); steady-state in 4-5 days
Duration
24 hours (QD dosing)
Half-life
~10 hours
Bioavailability
~49% (food increases Cmax by 50% and AUC by 20%)
Protein binding
~90%
Metabolism
Extensive hepatic via CYP3A4 (major) and CYP1A2 to inactive metabolites
Excretion
~69% fecal (metabolites); ~24% renal (metabolites)
Contraindications
- Moderate or severe hepatic impairment (Child-Pugh B/C)
- Concomitant strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir)
- Hypersensitivity to alfuzosin
- Prior hypotension / syncope with alpha-blockers
Side effects
Common
DizzinessHeadacheFatigueOrthostatic hypotensionNasal congestion / rhinitisUpper respiratory infectionEjaculatory dysfunction (retrograde ejaculation, reduced semen volume)
Serious
- Syncope (first-dose phenomenon)
- Intraoperative floppy iris syndrome (IFIS) during cataract surgery
- Priapism (rare)
- Severe hypotension
- Angioedema
- Hepatotoxicity (rare—cholestatic hepatitis reported)
Pregnancy & lactation
Pregnancy
Not indicated in pregnancy; animal studies show no teratogenicity.
Lactation
Excretion in breast milk unknown; not indicated in women.
Drug interactions
Strong Cyp3a4 Inhibitors
Contraindicated
Database
Increases alfuzosin levels 2-3 fold; severe hypotension and syncope risk.
Contraindicated. Use alternative BPH therapy if these drugs needed.
Source: Kimi deep-research + Cla
Amiodarone
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Amisulpride
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amprenavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Anagrelide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Arsenic Trioxide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Atazanavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Bedaquiline
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Bepridil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Boceprevir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Cabozantinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Alfuzosin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19