What is the use of Terazosin (Hytrin)?

From the Guidelines

Terazosin is a recommended treatment option for patients with moderate to severe symptoms of benign prostatic hyperplasia (BPH) and should be considered as a first-line therapy, as evidenced by the 2023 European Association of Urology guidelines 1.

Key Points to Consider

• The typical starting dose of terazosin for BPH is 1 mg at bedtime, which can be increased to 5-10 mg daily based on symptom improvement, as suggested by various studies, including those referenced in the 2021 AUA guideline 1.
• Terazosin works by relaxing smooth muscles in the prostate and blood vessels, improving urine flow and reducing symptoms of BPH, with its efficacy supported by multiple phase III randomized control trials and meta-analyses 1.
• Common side effects of terazosin include dizziness, headache, drowsiness, and nasal congestion, with orthostatic hypotension being a significant concern, particularly with the first dose and when increasing dosage, as noted in the 2003 AUA guideline 1.
• The choice of alpha blocker, including terazosin, should be based on patient age and comorbidities, as well as different adverse event profiles, such as ejaculatory dysfunction and changes in blood pressure, as recommended by the 2021 AUA guideline 1.

Clinical Considerations

• Patients should be aware of the potential for orthostatic hypotension and take precautions when driving or performing hazardous activities, especially when starting treatment with terazosin, as advised in the example answer.
• The 2023 European Association of Urology guidelines provide a comprehensive overview of the management of non-neurogenic male lower urinary tract symptoms, including the use of alpha blockers like terazosin, and should be consulted for further guidance 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. Terazosin Capsules relax the tightness of a certain type of muscle in the prostate and at the opening of the bladder

The primary uses of Terazosin are to:

• Treat hypertension by relaxing blood vessels
• Treat benign prostatic hyperplasia (BPH) by relaxing muscles in the prostate and at the opening of the bladder 2 It is also indicated for the treatment of symptomatic BPH and hypertension 2

From the Research

Terazosin Overview

• Terazosin is an alpha 1 blocker used to treat hypertension and symptomatic benign prostatic hyperplasia (BPH) 3, 4, 5, 6, 7
• 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 Treating BPH

• Terazosin has been shown to improve symptoms and peak urine flow rate in men with BPH, with significant reductions in Boyarsky symptom scores and increases in peak urinary flow rate 3, 5, 6, 7
• The efficacy of terazosin is reflected in increases in peak urinary flow rate and reductions in obstructive and irritative symptom scores compared to placebo 4
• Clinical improvements begin to occur within 2 weeks and have been sustained for up to 2 years 4

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, 7
• Adverse events associated with terazosin are relatively minor and reversible, including dizziness, asthenia, headache, and postural hypotension 6, 7

Comparison to Other Treatments

• Terazosin has been compared to other alpha-blockers, finasteride, and microwave therapy (TUMT), with similar efficacy to other alpha-blockers and superior efficacy to finasteride and placebo 7
• The available evidence suggests that terazosin improves urinary symptoms and flow measures associated with BPH, with effectiveness superior to placebo or finasteride, similar to other alpha-blockers, but less than TUMT 7