السلام عليكم
خلاصة الكلام انو كلهم تقريبا بنفس الفعالية بس الاختلاف بالاثار الجانبية وبالتداخلات
يعني حسب حالة المريض
Tamsulosin is more selective for all subtypes, but the ratio of selectivity for the α1A subtype to α1B or α1D is greater for silodosin than tamsulosin. Despite this higher receptor affinity, all alpha-antagonists with the exception of silodosin seem to have equal clinical efficacy, though clinical studies comparing all agents are currently lacking.[3]
As silodosin was approved in 2008, it has only been compared head to head in a 12-week clinical trial with tamsulosin.[10] Silodosin was found to be noninferior to tamsulosin; however, it must be noted that the dose of tamsulosin used in the study (0.2 mg/day) is half the dose approved for clinical use in the U.S. (0.4 mg/day). Most of the alpha-antagonists must be titrated slowly to effective doses with the exception of alfuzosin and silodosin, which can be started at their recommended dose on day 1.[3]
The main difference between the various alpha-antagonists appears to be their side-effect profiles. The second-generation alpha-antagonists (alfuzosin, doxazosin, terazosin) are all likely to have hypotensive and other syncopal events associated with their use, with alfuzosin causing less hypotension than the other two second-generation medications.[11] These adverse effects are dose related, so the lowest effective dose should be used. Alfuzosin may also cause abnormal ejaculations; however, the newer generation agents, tamsulosin and silodosin, are more likely to cause abnormal ejaculations, with silodosin causing more retrograde ejaculation than tamsulosin.[12,13] Dizziness has been associated with all agents.
Although rare, another adverse effect of the alpha-antagonists is intraoperative floppy iris syndrome (a complication of cataract surgery). When offered alpha-antagonist treatment, men should be asked if cataract surgery is planned, and therapy should be delayed until after the procedure is completed. Tamsulosin has the most reported cases of floppy iris syndrome.[14]
All agents should be started at the lowest dose if the patient is concurrently taking a phosphodiesterase type 5 (PDE-5) inhibitor and vice versa because of the possibility of a systemic hypotensive reaction with concurrent use.[15–17] Alfuzosin and silodosin are contraindicated in use with concurrent potent CYP3A4 inhibitors, and silodosin is not recommended for use with potent P-glycoprotein inhibitors