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To the Editor: Dr Kaplan and colleagues¹ assessed the efficacy of tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. We are concerned about 2 issues that may have had an effect on the observed efficacy and tolerability of the evaluated treatments.

First, there was no mention of adrenergic agonists or drugs with adverse anticholinergic effects in the list of excluded medical treatments. Adrenergic agonists, particularly those that possess activity at the -1 receptor—such as pseudoephedrine, ephedrine, and phenylephrine—can exacerbate the symptoms of BPH.² Use of an -1 agonist would also be expected to decrease the response to tamsulosin due to competitive inhibition at the receptor. In addition, first-generation antihistamines—such as chlorpheniramine and diphenhydramine—cause adverse anticholinergic effects and can be associated with urinary difficulties in men with a history of prostate problems.³ If the exclusion criteria of antimuscarinic agents included antihistamines, it was not . . . [Full Text of this Article]

William Andrew Bell, BS
wbell@utmem.edu

Naseem Amarshi, MSc, PharmD
University of Tennessee College of Pharmacy
Memphis

RELATED LETTERS

Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder
Toby C. Chai
JAMA. 2007;297(11):1191-1192.
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Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder
James G. Young and Kesavapilla Subramonian
JAMA. 2007;297(11):1192-1193.
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Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder—Reply
Steven A. Kaplan, Claus G. Roehrborn, Eric S. Rovner, Tamara Bavendam, and Zhonghong Guan
JAMA. 2007;297(11):1193.
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