From the Guidelines
Terazosin can generally be used in patients with chronic kidney disease (CKD), but caution is advised. The medication does not typically require dose adjustments for kidney impairment since it's primarily metabolized by the liver 1. However, patients with CKD may be more sensitive to the blood pressure-lowering effects of terazosin, particularly when starting therapy or increasing doses.
Key Considerations
- The usual starting dose is 1 mg at bedtime, which can be gradually increased as needed and tolerated.
- Common side effects include dizziness, lightheadedness, and orthostatic hypotension (blood pressure drop when standing up), which may be more pronounced in CKD patients.
- It's essential to monitor blood pressure closely, especially when initiating treatment.
- Always take the first dose at bedtime to minimize the risk of fainting, and rise slowly from sitting or lying positions. While terazosin is generally safe in CKD, your healthcare provider should evaluate your specific kidney function, other medications, and overall health status before prescribing this medication to ensure it's appropriate for your individual situation 1.
From the FDA Drug Label
Impaired renal function had no significant effect on the elimination of terazosin, and dosage adjustment of terazosin to compensate for the drug removal during hemodialysis (approximately 10%) does not appear to be necessary.
Terazosin can be taken with CKD. The drug label states that impaired renal function has no significant effect on the elimination of terazosin, and dosage adjustment is not necessary, even in patients undergoing hemodialysis 2.
From the Research
Terazosin and CKD
- Terazosin can be safely administered to patients with renal insufficiency without altering the usual dosing regimen 3.
- Renal insufficiency was not shown to affect the pharmacokinetics of terazosin in patients receiving oral terazosin (1 mg once daily) for two weeks 3.
- The plasma half-life of terazosin in patients with normal renal function was 10.0 hours, compared with 8.4 hours in patients with moderate renal insufficiency and 9.8 hours in the group with severe renal insufficiency 3.
Kidney Disease Progression
- Alpha-blocker use, including terazosin, is associated with a higher risk for kidney disease progression, but a lower risk for cardiac events and mortality compared with alternative BP-lowering medications 4.
- The risk of kidney disease progression associated with alpha-blocker use was not modified by the level of eGFR 4.
Management of CKD
- Management goals for CKD include mitigation of CKD risk factors to slow disease progression, including optimizing management of underlying conditions (eg, hypertension, diabetes) 5.
- Preservation of kidney function can improve outcomes and can be achieved through non-pharmacological strategies (eg, dietary and lifestyle adjustments) and chronic kidney disease-targeted and kidney disease-specific pharmacological interventions 6.
Safety Considerations
- Adverse experiences were reported by four patients and caused one patient to withdraw from the study, including symptoms such as gastralgia, headache, dizziness, malaise, weakness, and palpitations 3.
- Postural hypotension may occur in some patients after an initial dose of 1 mg of doxazosin, a similar alpha-blocker 7.