What is the use of Terazosin (Hytrin)?

From the Guidelines

Terazosin is a recommended treatment option for patients with bothersome, moderate to severe lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH).

Key Points

• The choice of alpha blocker, such as terazosin, should be based on patient age and comorbidities, as well as different adverse event profiles, including ejaculatory dysfunction and changes in blood pressure 1.
• Terazosin works by relaxing smooth muscles in the prostate, improving urine flow, and is typically started at a dose of 1 mg at bedtime, potentially increasing to 5-10 mg daily based on symptom improvement.
• Common side effects of terazosin include dizziness, headache, drowsiness, weakness, and nasal congestion, and patients should be advised to rise slowly from sitting or lying positions to reduce the risk of orthostatic hypotension.
• A complete medication review is essential before starting terazosin, as it may interact with other blood pressure medications, erectile dysfunction drugs, and certain antidepressants.

Treatment Considerations

• According to the AUA guideline, clinicians should offer one of the following alpha blockers as a treatment option for patients with bothersome, moderate to severe LUTS/BPH: alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin 1.
• The guideline also recommends considering patient age and comorbidities, as well as different adverse event profiles, when choosing an alpha blocker 1.
• Multiple phase III randomized control trials, phase IV studies, systematic reviews, and meta-analyses have demonstrated the efficacy of alpha blockers, including terazosin, for LUTS and BPH since the 1980s 1.

From the FDA Drug Label

Terazosin Capsules are used to treat high blood pressure (hypertension). Terazosin Capsules are also used to treat benign prostatic hyperplasia (BPH) in men. Terazosin Capsules work by relaxing blood vessels so that blood passes through them more easily. This helps to lower blood pressure. Terazosin Capsules relax the tightness of a certain type of muscle in the prostate and at the opening of the bladder This may increase the rate of urine flow and/or decrease the symptoms you are having.

The primary uses of Terazosin are to:

• Treat hypertension by relaxing blood vessels and lowering blood pressure
• Treat benign prostatic hyperplasia (BPH) by relaxing muscles in the prostate and increasing urine flow 2 It can be used alone or in combination with other antihypertensive agents 2

From the Research

Terazosin Overview

• Terazosin is an alpha 1 blocker used to treat hypertension and symptomatic benign prostatic hyperplasia (BPH) 3, 4.
• It works by selectively antagonizing alpha 1-adrenoceptor-mediated contraction of the prostate, prostatic capsule, proximal urethra, and bladder base, reducing urethral pressure, bladder outlet resistance, and urinary symptoms associated with BPH 4.

Efficacy in BPH Treatment

• Terazosin has been shown to significantly improve American Urology Association (AUA) symptom and quality-of-life scores, as well as increase peak urinary flow rate, in men with BPH 5.
• In a large randomized US trial, treatment with terazosin for 1 year improved mean AUA symptom score and peak urinary flow rate to a significantly greater extent than finasteride 5 mg/day in men with moderate to severe BPH 5.
• Terazosin produced a mean reduction of 55% in overall Boyarsky scores, 57% in obstructive symptom scores, and 54% in irritative symptom scores in patients with BPH symptoms 3.

Safety and Tolerability

• Terazosin is generally well tolerated, but caution is recommended at treatment initiation and when dosage adjustments are made due to an increased risk of postural hypotension and related adverse effects 4, 5.
• The most frequently reported adverse events associated with terazosin include dizziness, asthenia, postural hypotension, somnolence, headache, peripheral oedema, nasal congestion/rhinitis, and syncope 5.
• Approximately 5% of men with BPH discontinue terazosin because of adverse events 5.

Pharmacoeconomic Evaluation

• An economic evaluation of terazosin showed that it was significantly more effective than placebo in improving disease-specific symptoms and quality of life, but at a similar overall cost to placebo 5.
• Another economic analysis favored terazosin, with private insurance costs per patient undergoing primary treatment with TURP being $US6411, compared with $US2860 with finasteride and $US2422 with terazosin 5.