What is the recommended treatment and dosage for benign prostatic hyperplasia (BPH) and hypertension using Terazosin (Hytrin)?

From the Guidelines

Terazosin (Hytrin) is typically prescribed at an initial dose of 1 mg at bedtime for both benign prostatic hyperplasia (BPH) and hypertension, with gradual titration based on patient response, as recommended by the most recent guidelines 1.

Key Considerations

• For BPH, the dose can be increased to 2 mg, 5 mg, and eventually 10 mg once daily, with most patients requiring 5-10 mg daily for symptom relief.
• For hypertension, the dose may be adjusted to 1-5 mg daily, with some patients needing up to 20 mg for adequate blood pressure control.
• Taking terazosin at bedtime is recommended to minimize first-dose orthostatic hypotension, a common side effect characterized by dizziness or fainting when standing up.

Mechanism and Side Effects

• Terazosin works by blocking alpha-1 adrenergic receptors, which relaxes smooth muscle in the prostate and blood vessels, improving urinary flow in BPH and reducing peripheral resistance in hypertension.
• Patients should be monitored for other side effects including headache, weakness, and nasal congestion.

Important Warnings

• Patients should avoid abrupt discontinuation and consult their healthcare provider before taking other medications, particularly other antihypertensives or erectile dysfunction drugs, to prevent potentially dangerous interactions.
• The medication may take 2-6 weeks for full effect in BPH symptoms, while blood pressure effects can begin within hours.

Guideline Recommendations

• The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines recommends terazosin as a second-line agent for patients with concomitant BPH and hypertension 1.
• The guidelines also emphasize the importance of gradual titration and monitoring for side effects to ensure optimal treatment outcomes.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION If Terazosin Capsules administration is discontinued for several days, therapy should be reinstituted using the initial dosing regimen. Benign Prostatic Hyperplasia Initial Dose: 1 mg at bedtime is the starting dose for all patients, and this dose should not be exceeded as an initial dose The dose should be increased in a stepwise fashion to 2 mg, 5 mg, or 10 mg once daily to achieve the desired improvement of symptoms and/or flow rates. Hypertension The dose of Terazosin Capsules and the dose interval (12 or 24 hours) should be adjusted according to the patient's individual blood pressure response. The usual recommended dose range is 1 mg to 5 mg administered once a day; however, some patients may benefit from doses as high as 20 mg per day

The recommended treatment and dosage for Benign Prostatic Hyperplasia (BPH) using Terazosin (Hytrin) is:

• Initial dose: 1 mg at bedtime
• Subsequent doses: increased in a stepwise fashion to 2 mg, 5 mg, or 10 mg once daily For Hypertension, the recommended dosage is:
• Initial dose: 1 mg at bedtime
• Subsequent doses: slowly increased to achieve the desired blood pressure response, with a usual recommended dose range of 1 mg to 5 mg administered once a day, and some patients may benefit from doses as high as 20 mg per day 2

From the Research

Treatment of Benign Prostatic Hyperplasia (BPH) and Hypertension with Terazosin

• Terazosin is a selective alpha 1 blocker that can be used to treat both BPH and hypertension 3, 4, 5, 6, 7.
• The recommended dosage of terazosin for BPH is 1-10 mg daily, with some studies suggesting that doses up to 20 mg daily may be effective 5, 6, 7.
• For hypertension, the recommended dosage of terazosin is 1-5 mg daily, with a starting dose of 1 mg daily and titration upward as needed 3.

Efficacy of Terazosin in BPH

• Terazosin has been shown to improve symptoms of BPH, including obstructive and irritative symptoms, and to increase peak urine flow rate 4, 5, 6, 7.
• Studies have demonstrated that terazosin can reduce Boyarsky symptom scores by 40-55% and increase peak urinary flow rate by 30-47% 5, 6.
• Long-term studies have shown that terazosin is effective and well-tolerated for up to 42 months 7.

Safety of Terazosin

• Common adverse events associated with terazosin include dizziness, asthenia, and somnolence 5, 6, 7.
• Orthostatic hypotension is a concern with the use of alpha 1 blockers, including terazosin, especially in the elderly 3.
• Fluid retention is also a potential concern, which may be overcome by combining terazosin with a diuretic 3.

Special Considerations

• Terazosin may be particularly useful in patients with both BPH and hypertension, as it can treat both conditions simultaneously 3, 4.
• The choice of alpha 1 blocker and dosage should be individualized based on the patient's baseline characteristics and response to treatment 4.