Reacting to the news that tamsulosin, for men's urinary problems - previously only available on prescription - is now available through pharmacies, Graham Phillips, pharmacist, and Royal Pharmaceutical Society English Pharmacy Board Member said:

"Racks of make-up and no spanners" 1 was the title of a report published by the Men's Health Forum in 2009. It pointed out that pharmacists had a significant role to play in improving outcomes for men. The report asked directly - what do we need to do to get men engaged in healthcare through pharmacy? Today's launch answers that question by providing men who have urinary problems access to a health professional on the high street to discuss their symptoms at a time convenient to them- and that can be done in confidence - the vast majority pharmacies now have a private consultation area."

And adds:
"Pharmacists are ideally placed to complement the role of GP's and other health providers by both treating symptoms of benign prostatic hyperplasia and crucially picking up the signs of more serious illness early - improving the chance of a good outcome. "


1 "Racks of make-up and no spanners: an action research project into men's use of pharmacy to improve their health" Dr Gillian Granville on behalf of Men's Health Forum


What condition is Over The Counter (OTC) tamsulosin used for?

Tamsulosin is used for the treatment of symptoms of benign prostatic hyperplasia (BPH) in males aged 45 to 75 years. Symptoms include; Difficulty when starting urinating, urinating for longer or more frequently, needing to do so again within a short period of time, needing to get up to urinate several times at night and leaking. Dose: A single 400 microgram capsule should be swallowed whole after the same meal each day. How is Tamsulosin supplied over the counter by pharmacists?

What is benign prostatic hyperplasia (BPH)?

Prostate enlargement, also known as benign prostatic hyperplasia (BPH), is a common condition. An estimated one in four men over the age of 40 suffer from BPH.1 The cause is unknown, but ageing and long-term exposure to testosterone and particularly dihydrotestosterone are important.

The symptoms of prostate enlargement are caused by the enlarged prostate placing pressure on the bladder and urethra - this can cause 'functional' lower urinary tract symptoms (LUTS) such as hesitancy, weak stream and urgency.

The International Prostate Symptom Score (IPSS) is a validated scoring system that categorises the overall severity of LUTS as mild, moderate or severe. The IPSS severity score is also useful for monitoring progress and response to treatment. 2 Severity of LUTS should ideally be assessed using a validated scoring system such as the IPSS with questioning (age, other medication, medical history etc) to help determine eligibility for supply.

In some men, the symptoms are mild and do not require treatment - watchful waiting is a suitable approach for mild or moderate disease. It involves regular (at least annual) monitoring, with a physical examination and an assessment of symptoms / patient preferences.

How is Tamsulosin supplied over the counter by pharmacists?

Pharmacists can make a 2 week initial supply to patients with BPH symptoms. If there has been an improvement in urinary symptoms, pharmacists can make a further 4 weeks OTC supply of tamsulosin.

If there are contraindications or symptoms are not relieved or are getting worse after the first 2 weeks then the patient must be referred to a doctor.

Patients must be advised to see their doctor within 6 weeks of starting treatment for assessment of their symptoms and confirmation they can continue to take OTC tamsulosin.

Pharmacists will ensure (by asking the patient) that a clinical assessment has taken place within 6 weeks of starting OTC tamsulosin to enable further supply. Further supply after 6 weeks can be made if the patient confirms that the doctor has carried out a clinical assessment and agreed further supplies are suitable.

Every 12 months the patient should see their doctor for a review.

1 Reclassification encourages men to play a more active role in their healthcare. MHRA Press Release, December 2009

2 Clinical Knowledge Summaries. How should I assess someone with benign prostatic hyperplasia? (date accessed: 23rd February 2010)

Royal Pharmaceutical Society of Great Britain

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