What is the use of Terazosin (Hytrin)?

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 1.

Key Points

• Terazosin is an alpha-1 adrenergic receptor blocker that relaxes smooth muscles in blood vessels and the prostate, improving urine flow in BPH and lowering blood pressure by reducing peripheral vascular resistance.
• The medication is effective in partially relieving symptoms, producing on average a 4-to-6 point improvement in the AUA Symptom Index 1.
• Common side effects include dizziness, headache, drowsiness, and nasal congestion, with orthostatic hypotension being most pronounced with the first dose and when increasing dosage.
• Patients should be aware of the risk of orthostatic hypotension and exercise caution when driving or performing hazardous activities, especially when starting treatment.

Treatment Considerations

• The combination of an alpha-adrenergic receptor blocker and a 5 alpha-reductase inhibitor (combination therapy) is an appropriate and effective treatment for patients with LUTS associated with demonstrable prostatic enlargement 1.
• The Panel assumes that the combination of any effective alpha blocker and 5 alpha-reductase inhibitor probably produces a comparable benefit, with the best-tested combination being doxazosin and finasteride 1.
• The safety of specific combinations other than finasteride plus doxazosin, terazosin, and alfuzosin has not been assessed 1.

Monitoring and Follow-up

• Patients should be monitored for adverse events, including orthostatic hypotension, dizziness, and ejaculatory dysfunction.
• Regular follow-up appointments should be scheduled to assess symptom improvement and adjust treatment as needed.

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 a selective alpha 1-adrenoceptor antagonist used to treat benign prostatic hyperplasia (BPH) 3, 4, 5, 6, 7
• It works by reducing urethral pressure, bladder outlet resistance, and urinary symptoms associated with BPH 3

Efficacy of Terazosin

• Terazosin has been shown to improve symptom scores and peak urinary flow rates in patients with BPH 3, 4, 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 with placebo 3
• Clinical improvements begin to occur within 2 weeks and have been sustained for up to 2 years 3

Comparison with Other Treatments

• Terazosin has been compared with other alpha-1 blockers, such as prazosin and tamsulosin, and has been shown to have a similar efficacy profile 4
• Terazosin has also been compared with finasteride and has been shown to be more effective in improving symptom scores and peak urinary flow rates 7

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 3, 5, 6, 7
• Adverse events associated with terazosin include dizziness, asthenia, headache, and postural hypotension 5, 6, 7

Study Outcomes

• A systematic review of 17 studies involving 5,151 subjects found that terazosin improved symptom scores and flow rates more than placebo or finasteride and similarly to other alpha antagonists 7
• The pooled mean percentage improvements for the Boyarsky symptom score was 37% for terazosin versus 15% for placebo 7