1. 門診處方用藥討論 Allopurinol for chronic prostatitis 報告者 : 李安儀

2. Allopurinol for chronic prostatitis (Cochrane Review) McNaughton Collins M, Wilt T ABSTRACT A substantive amendment to this systematic review was last made on 01 August 2002. Cochrane reviews are regularly checked and updated if necessary. Background: Chronic prostatitis is a condition that causes men substantial morbidity through the associated constellation of urinary symptoms, sexual dysfunction, and pelvic pain. The etiology of chronic prostatitis is unknown, and the many and varied treatments for chronic prostatitis reflect in part this knowledge gap. One novel etiologic theory is that the reflux of urine into prostatic ducts causes prostatic inflammation via high concentrations of purine and pyrimidine base-containing metabolites in prostatic secretions. This theory has led to the use of allopurinol for treatment of chronic prostatitis in hopes of lowering prostatic levels of uric acid and improving symptoms. Objectives: To determine the effects of allopurinol in the treatment of chronic prostatitis Search strategy: Trials were searched in computerized general and specialized databases (MEDLINE, Cochrane Library, Cochrane Prostate Group database), bibliographies of obtained articles, and direct contact with authors. Selection criteria: All randomized trials of allopurinol versus placebo used to treat patients with chronic prostatitis. Acute prostatitis, bacterial prostatitis, and asymptomatic prostatitis were excluded. The main outcome measure was the change in patient-reported discomfort. Data collection and analysis: The reviewers extracted the data independently for the outcomes of change in patient-reported discomfort, investigator graded prostate pain, leukocyte counts, and biochemical indices. Reviewers' conclusions: One small trial of allopurinol for treating chronic prostatitis showed improvements in patient-reported symptom improvement, investigator-graded prostate pain, and biochemical parameters. However, the data provided, the measures used, and the statistics presented do not make these findings convincing that changes in urine and prostatic secretion composition regarding purine and pyrimidine bases resulted in the relief of symptoms. Further studies of allopurinol treatment using standardized and validated outcomes measures and analyses are necessary to determine whether allopurinol is effective.

5. allopurinol FDA labeled indications Antineoplastic-induced hyperuricemia Calcium oxalate calculi Gout Uric acid calculi Dosage adults: Calcium oxalate calculi: 200-300 mg PO as a single or divided dose (2-3 times daily); maximum dose: 300 mg/dose; 800 mg/day Gout, mild:PO initial: 100-300 mg/day as a single or divided dose (2-3 times daily); moderately severe (tophaceous): 400-600 mg/day as a single or divided dose (2-3 times daily); maximum dose 800 mg/day Neoplastic disease therapy: 600-800 mg/day, 12 hours to 3 days prior to initiation of chemotherapy Uric acid calculi: 100-200 mg 1 to 4 times daily or 300 mg once daily; maximum dose: 300 mg/dose; 800 mg/day Dosage, Pediatric, (usual) Neoplastic disease therapy: (under 6yrs) 50 mg PO 3 times daily Neoplastic disease therapy: (6-10yrs) 100 mg PO 3 times daily or 300 mg once daily

6. Chronic Bacterial Prostatitis Antibiotics -- Therapy must cover all likely pathogens in the context of this clinical setting. Sulfamethoxazole and trimethoprim: 80 mg TMP/400 mg SMZ PO bid for 4-6 wk Ciprofloxacin: 500 mg PO bid for 4 wk Doxycycline: 200-300 mg PO divided bid Gentamicin: 1.5 mg/kg/dose IV/IM Alpha-adrenergic blocking agents -- These agents relax the smooth muscle to the bladder neck, thus reducing bladder outlet obstruction. ． Terazosin: 1 mg PO qhs; increase slowly to effect; not to exceed 10 mg/d Doxazosin:1mg PO qd; may increase to 2 mg qd thereafter and titrate to higher doses over several wk as necessary; not to exceed 8 mg/d by 2004, eMedicine.com, Inc.

7. Nonbacterial Prostatitis Nonbacterial prostatitis refers to a condition affecting patients who present with symptoms of prostatitis without a positive result after urine culture or expressed prostate secretion (EPS) culture. Antibiotics -- These are often used on a trial basis despite a negative culture result to check for symptom improvement and to rule out infection with a fastidious organism. Sulfamethoxazole and trimethoprim: 80 mg TMP/400 mg SMZ PO bid Ciprofloxacin: 250-500 mg PO bid Levofloxacin:250-500 mg PO qd Antihypertensives -- Selective alpha-1 receptor blockers relax smooth muscle in the prostate and bladder neck. Found to improve symptoms of prostatic obstruction. Doxazosin: 1 mg hs for 7-14 d, titrate up to 2 mg for next 7-14 d, then up to 4 mg; reassess symptoms and maintain 4-mg dose or increase to 8 mg Terazosin: 1 mg for 1-2 wk, then 2 mg for 1-2 wk, then advanced to 5 mg; reevaluate; may need to advance to 10 mg Nonsteroidal anti-inflammatory agents -- Inhibit action of cyclooxygenase, which results in decrease of prostaglandin synthesis. Ibuprofen: Prostatitis: 600-800 mg PO tid Benzodiazepines -- Work on limbic system, thalamus, and hypothalamus, inducing a calming effect and relieving anxiety and skeletal muscle spasm. Diazepam: 2-5 mg tid/qid for muscle relaxation; increase to 10 mg prn Tamsulosin: 0.4-0.8 mg PO qd Uricosurics -- Reduce uric acid levels. Has no analgesic or anti-inflammatory activity. Allopurinol : 220-300 mg qd/bid Muscle relaxants -- Helpful in relieving discomfort associated with tonically contracted muscles. Methocarbamol: 1.5 g PO qid for 2-3 d; then decrease to 4-4.5 g/d in 3-6 divided doses Urinary incontinence agents -- Used for treatment of overactive bladder to prevent associated symptoms of urinary frequency, urgency, and incontinence. Tolterodine tartrate: 2 mg PO bid; reduce to 1 mg bid if patient does not tolerate medication well by 2004, eMedicine.com, Inc.

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