From the Guidelines
Terazosin should be prescribed over Flomax (Tamsulosin) for patients with benign prostatic hyperplasia (BPH) when cost is a significant concern or when patients have concurrent hypertension, as it can effectively treat both conditions simultaneously. When considering the treatment of BPH, it's essential to weigh the benefits and drawbacks of each medication. According to the AUA guideline on management of BPH 1, alpha-blocker therapy is a suitable treatment option for patients with LUTS secondary to BPH. The guideline states that alfuzosin, doxazosin, tamsulosin, and terazosin are appropriate treatment options, with equal clinical effectiveness. However, terazosin may be preferred for patients with concurrent hypertension, as it can be used to manage both conditions simultaneously with doses ranging from 1-20 mg daily.
Some key points to consider when choosing between terazosin and tamsulosin include:
- Cost: Terazosin is available as a generic medication and is typically less expensive than tamsulosin.
- Concurrent hypertension: Terazosin can effectively treat both BPH and hypertension simultaneously.
- Dose titration: Terazosin requires dose titration to minimize orthostatic hypotension, while tamsulosin typically doesn't require titration.
- Side effects: Both medications can cause orthostatic hypotension, dizziness, and ejaculatory problems, but the incidence of these side effects may vary between the two medications.
- Insurance coverage: The choice between terazosin and tamsulosin may also depend on individual patient factors, including insurance coverage and comorbidities.
It's also worth noting that the AUA guideline 1 suggests that large, well-designed, direct comparator trials are needed to substantiate claims of superior safety between the different alpha-blocking agents. However, based on the current evidence, terazosin appears to be a suitable alternative to tamsulosin for patients with BPH, particularly when cost is a concern or when patients have concurrent hypertension.
From the Research
Terazosin vs Flomax (Tamsulosin) for BPH
Terazosin and Flomax (Tamsulosin) are both alpha-blockers used to treat benign prostatic hyperplasia (BPH). However, there are certain situations where Terazosin may be prescribed over Flomax:
- Hypertension: Terazosin has been shown to lower blood pressure in hypertensive patients, making it a good option for patients with BPH and hypertension 2, 3.
- Concomitant antihypertensive medication: Terazosin can be safely used in patients taking other antihypertensive medications, without adverse effects on blood pressure 3.
- Symptom score improvement: Terazosin has been shown to produce significant improvements in symptom scores, particularly in patients with severe symptoms 4, 5.
- Long-term efficacy and safety: Terazosin has been shown to be effective and well-tolerated in long-term treatment of BPH, with significant improvements in peak urinary flow rates and symptom scores 6.
Comparison with Tamsulosin
- Efficacy: Terazosin has been shown to be more effective than Tamsulosin in improving symptom scores, particularly in patients with severe symptoms 4.
- Blood pressure effects: Tamsulosin has been shown to have minimal effects on blood pressure, making it a safer option for patients with hypertension who have impaired blood pressure regulation 4.
- Adverse events: Both Terazosin and Tamsulosin have similar adverse event profiles, with dizziness, asthenia, and somnolence being the most common adverse events 6.