From the Guidelines
Terazosin is a recommended treatment option for patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), with a typical starting dose of 1 mg at bedtime, potentially increasing to 5-10 mg daily based on symptom improvement, as supported by the 2003 AUA guideline on management of BPH 1.
Key Points
- Terazosin is an alpha-1 adrenergic blocker that relaxes smooth muscles in blood vessels and the prostate, improving urinary symptoms in BPH and lowering blood pressure in hypertension.
- The medication is typically taken at bedtime to minimize the risk of first-dose orthostatic hypotension, and patients should rise slowly from sitting or lying positions, especially when starting treatment.
- Common side effects include dizziness, headache, drowsiness, and orthostatic hypotension, and the medication may take several weeks to achieve full effectiveness for BPH symptoms.
- According to the 2023 European Association of Urology guidelines on the management of non-neurogenic male LUTS, alpha-blocker therapy, including terazosin, is a recommended treatment option for patients with LUTS secondary to BPH 1.
Dosage and Administration
- For hypertension, the typical starting dose is 1 mg at bedtime, gradually increasing to 2-5 mg daily as needed, with a maximum dose of 20 mg daily.
- For BPH, treatment usually begins with 1 mg at bedtime, potentially increasing to 5-10 mg daily based on symptom improvement.
Efficacy and Safety
- Meta-analyzed data from the 2003 AUA guideline on management of BPH suggest that terazosin, along with other alpha-blockers, is effective in partially relieving symptoms, producing on average a 4-to-6 point improvement in the AUA Symptom Index 1.
- The adverse event profile of terazosin appears similar to that of other alpha-blockers, with a slight difference in the probability of orthostatic hypotension and ejaculatory dysfunction 1.
From the FDA Drug Label
Terazosin Capsules, USP are indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH). Terazosin Capsules are used to treat high blood pressure (hypertension). Terazosin Capsules are also used to treat benign prostatic hyperplasia (BPH) in men.
The primary uses of Terazosin are to treat:
- Hypertension (high blood pressure)
- Benign Prostatic Hyperplasia (BPH) in men Terazosin works by relaxing blood vessels to lower blood pressure and by relaxing the tightness of a certain type of muscle in the prostate and at the opening of the bladder to increase the rate of urine flow and/or decrease the symptoms of BPH 2 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 was approved in 1993 for use in the treatment of BPH symptoms 3
Efficacy in Treating BPH
- Terazosin has been shown to improve BPH voiding symptoms, with a mean reduction of 55% in overall Boyarsky scores, 57% in obstructive symptom scores, and 54% in irritative symptom scores 3
- It also improves peak urine flow rate, with a mean increase of 2.6 mL/s (30%) in terazosin-treated patients compared to 1.2 mL/s (14%) in placebo-treated patients 6
- Long-term efficacy and safety of terazosin in patients with BPH have been demonstrated, with significant improvements in peak urinary flow rates and Boyarsky symptom scores maintained over 42 months 7
Safety and Tolerability
- Terazosin is generally well tolerated, with mild or moderate side effects, and a low incidence of premature withdrawal due to adverse events 4, 5, 6, 7
- Common adverse events include dizziness, headache, and asthenia, but these are often mild and resolve with cessation of therapy 4, 6, 7
- Terazosin can be safely used in patients with hypertension, including those taking concurrent antihypertensive medications, with minimal reductions in blood pressure observed in normotensive patients 4, 5
Use in Hypertension
- Terazosin has been shown to lower blood pressure in patients with hypertension, with significant reductions in systolic and diastolic blood pressure observed in untreated and treated patients 3, 5
- It can be safely added to ongoing antihypertensive therapy, with minimal impact on blood pressure-related side effects 5