What are the key considerations before prescribing terazosin (alpha-1 adrenergic blocker) for Benign Prostatic Hyperplasia (BPH) or hypertension?

From the Guidelines

Before prescribing terazosin for BPH or hypertension, it is essential to assess the patient's cardiovascular status and start with a low dose of 1 mg at bedtime, gradually titrating upward to minimize the risk of first-dose hypotension, dizziness, and syncope. The patient's dose should be titrated upward to 5-10 mg daily for BPH or 1-20 mg daily for hypertension, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Key considerations include evaluating potential drug interactions, especially with other antihypertensives, phosphodiesterase-5 inhibitors like sildenafil, or medications that affect blood pressure, and using extra caution in elderly patients due to increased sensitivity to hypotensive effects. Additionally, patients with planned cataract surgery should be evaluated for Intraoperative Floppy Iris Syndrome, and regular follow-up is essential to monitor efficacy and adverse effects, as terazosin works by blocking alpha-1 adrenergic receptors, causing smooth muscle relaxation in the prostate and blood vessels, which improves urinary flow in BPH and reduces peripheral vascular resistance in hypertension. Some studies have shown that alpha-1 blockers like terazosin may be associated with orthostatic hypotension, especially in older adults 1. It is also important to note that terazosin is contraindicated in patients with hypersensitivity to quinazolines, and patients should be warned about orthostatic hypotension and advised to rise slowly from sitting or lying positions. The British Hypertension Society guidelines for hypertension management also provide guidance on the use of antihypertensive drugs, including alpha-1 blockers like terazosin, and emphasize the importance of individualizing treatment and monitoring patients regularly 1. Overall, the use of terazosin for BPH or hypertension requires careful consideration of the patient's individual needs and medical history, as well as regular monitoring to minimize the risk of adverse effects.

From the FDA Drug Label

You and your doctor should discuss Terazosin Capsules and your condition before you start taking it and at your regular check-ups. Terazosin Capsules are used to treat high blood pressure (hypertension). Terazosin Capsules are also used to treat benign prostatic hyperplasia (BPH) in men.

Before prescribing Terazosin for Benign Prostatic Hyperplasia (BPH) or hypertension, consider the following key points:

• The patient's overall health and medical condition should be discussed with the doctor before starting treatment with Terazosin Capsules.
• Terazosin Capsules are used to treat high blood pressure (hypertension) and benign prostatic hyperplasia (BPH) in men.
• The medication works by relaxing blood vessels to lower blood pressure and relaxing the tightness of a certain type of muscle in the prostate to increase urine flow and decrease BPH symptoms.
• Patients should be aware that Terazosin Capsules may not prevent the need for surgery in the future, even if symptoms improve.
• Patients should expect to see an effect on their symptoms within 2 to 4 weeks of starting the medication 2.

From the Research

Key Considerations Before Prescribing Terazosin

Before prescribing terazosin for Benign Prostatic Hyperplasia (BPH) or hypertension, several key considerations should be taken into account:

• Pharmacodynamic and Pharmacokinetic Properties: Terazosin is a post-synaptic alpha 1-adrenoceptor antagonist with a longer duration of action compared to prazosin, allowing for once-daily administration 3.
• Therapeutic Efficacy: Terazosin has been shown to be effective in reducing blood pressure in patients with mild to moderate essential hypertension, with little influence on heart rate 3.
• Administration and Dosing: Terazosin is normally administered once daily, starting at a dose of 1 mg/day and gradually titrating upwards as the blood pressure stabilizes at each new dose, until blood pressure is adequately controlled or to a maximum dose of 20mg daily 3.
• Side Effects: The most common side effects associated with terazosin treatment are dizziness, headache, asthenia, and nasal congestion, but these are usually mild and do not require treatment discontinuation 3.
• First-Dose Syncope: First-dose syncope occurs rarely after terazosin, and can largely be avoided by giving the first dose at bedtime 3.
• Effects on Blood Pressure and Heart Rate: Terazosin has been shown to produce significant reductions in blood pressure, with little influence on heart rate 3, 4.
• Treatment of BPH: Terazosin has been shown to be effective in treating symptomatic BPH, with significant improvements in voiding symptoms and urinary flow rates 5, 6.
• Comparison with Other Alpha Blockers: Terazosin has been compared to other alpha blockers, such as doxazosin, and has been shown to be effective and well-tolerated 7.

Special Considerations

• Orthostatic Hypotension: Terazosin can cause orthostatic hypotension, particularly with the first dose, and patients should be cautioned to rise slowly from a lying or sitting position 3, 4.
• Dose Titration: The dose of terazosin should be titrated slowly to minimize the risk of orthostatic hypotension and other side effects 3, 4.
• Concomitant Medications: Terazosin can be used in combination with other antihypertensive agents, but patients should be monitored closely for signs of orthostatic hypotension and other side effects 3.