Monday, July 17, 2017

#15 Warning: Some Drugs Make You Floppy in the Worst Way

This one is a little obscure, but it's a side effect of a common drug and completely avoidable. Read on:

Dear Dr. Tumoriffic,

I'm afraid my iris has gone all floppy. Why did this happen?

Mr. Floppy

Dear Mr. Floppy,

I'm so glad you brought up this subject! Readers, did you know that there is a truly scary way men (and women) can go floppy? And no, it's not polka music. It's drugs. In fact, it's a class of drugs*. And what gets floppy? It isn't your little friend, guys. It's your iris. And in the wrong situation, that can make you blind.

Let me introduce you to FLOPPY IRIS SYNDROME. Floppy iris syndrome--more correctly, intraoperative floppy iris syndrome (IFIS)--is when the muscles of the iris go slack. For most people, it doesn't matter. You won't know you have it, and it won't affect your vision. But cataract surgery could make you go blind.

Patients with IFIS are at high risk of going blind from cataract surgery. However, this is almost always preventable if your ophthalmologist (eye surgeon) knows that you have had certain drugs. Then, they can take precautions. So listen up!

The guilty class of drugs is the alpha-1 antagonists (you don't have to remember that phrase). These are drugs that are sometimes used to treat high blood pressure (which is why some women get IFIS from them), but, usually, they are used to treat benign prostatic hypertrophy (BPH).* This is a very common condition in men over 60.

One of these drugs is much more likely than the others to cause IFIS. It's tamsulosin (Flomax) and probably Silodosin (Rapaflo), because they are very similar. Even a single dose of tamsulosin in a lifetime forever puts you at risk for IFIS. Other common members of the class include alfuzosin (Uroxatral), doxazosin (Cardura), terazosin (Hytrin), and prazosin (Minipres)***. These others may do it, but they're much less of a problem.

Why am I telling you this? Because I saw a patient who had IFIS from tamsulosin and cataract surgery. His ophthalmologist didn't ask about it, and now, he is almost blind in one eye. So, remember this: if you have EVER taken tamsulosin or silodosin, make sure your eye surgeon knows this before you get cataract surgery.

Or, let's be real. Who will really remember these specifics? If you have EVER been treated for BPH, make sure your eye doctor knows before you have cataract surgery, and make sure they know your blood pressure meds! If your parent, aunt, uncle, etc. is having cataract surgery, make sure they tell them. Yes, I am sure almost all eye surgeons remember to ask, but not all of them do.

Oh, and guys, if you have that other kind of floppiness, don't worry. You don't have to tell your ophthalmologist about it. They really don't want to know.

Be well,

Dr. Tumoriffic

* The prostate gland is an organ that produces some of the ingredients of semen, so only guys get to have one.) It is shaped like a doughnut with a very small hole. The prostate is located just at the exit from the bladder, and, through the little hole runs the urethra. Unfortunately, the prostate, like the ears and the nose, continues to grow throughout the lifetime.** Sadly, the hole in the middle does not grow, but shrinks as the prostate grows in on it. That's what alpha-1 antagonists treat.

** As I always tell my patients that if we find the pill that will allow us to live forever, men are all going to look like caricatures of Ross Perot but with basketballs between our legs. Some have proposed that the first person who will live to be 150 has already been born. If that person is male. . .

*** Prazosin is the real weirdo of the bunch. In addition to BPH, it can also treat PTSD and the sting of the Indian red scorpion!

This cat is bored.

No comments:

Post a Comment