What is the recommended treatment regimen for a patient with benign prostatic hyperplasia (BPH) using Terazosin?

From the Guidelines

Terazosin is a recommended treatment option for patients with benign prostatic hyperplasia (BPH), with a typical starting dose of 1 mg taken orally once daily at bedtime, and can be titrated up to 10 mg daily based on symptom improvement and tolerability. The choice of alpha blocker, including terazosin, should be based on patient age and comorbidities, as well as different adverse event profiles, such as ejaculatory dysfunction and changes in blood pressure 1.

Key Considerations

• Terazosin works by blocking alpha-1 adrenergic receptors in the prostate and bladder neck, causing smooth muscle relaxation and improving urinary flow.
• Patients should be monitored for symptom improvement using standardized questionnaires and for side effects including dizziness, headache, and asthenia.
• Bedtime administration is recommended to reduce the risk of first-dose orthostatic hypotension, which can cause dizziness and fainting.
• Improvement may be noticed within 2 weeks, but full effects typically take 4-6 weeks.

Treatment Regimen

• The dose can be increased to 2 mg, 5 mg, and eventually 10 mg daily based on symptom improvement and tolerability, with most patients requiring 5-10 mg daily for optimal effect.
• Patients should be advised to rise slowly from sitting or lying positions, especially after the first dose or dose increases, and should avoid situations where injury could result if syncope occurs.
• Regular follow-up appointments are necessary to assess efficacy and adjust dosing as needed.

Combination Therapy

• Combination therapy with a 5-alpha-reductase inhibitor (5-ARI) may be considered for patients with LUTS associated with demonstrable prostatic enlargement, as it may reduce the risk of acute urinary retention and the need for BPH-related surgery 1.
• However, the choice of combination therapy should be based on individual patient factors, including the risk of progression and the patient's desire to avoid surgery.

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 Patients should be closely followed during initial administration in order to minimize the risk of severe hypotensive response. Subsequent Doses: 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. Doses of 10 mg once daily are generally required for the clinical response Therefore, treatment with 10 mg for a minimum of 4-6 weeks may be required to assess whether a beneficial response has been achieved.

The recommended treatment regimen for a patient with Benign Prostatic Hyperplasia (BPH) using Terazosin is:

• Initial dose: 1 mg at bedtime
• Subsequent doses: increased in a stepwise fashion to 2 mg, 5 mg, or 10 mg once daily
• Dose required for clinical response: 10 mg once daily
• Minimum treatment duration: 4-6 weeks to assess beneficial response 2

From the Research

Treatment Regimen for Benign Prostatic Hyperplasia (BPH) using Terazosin

The recommended treatment regimen for a patient with BPH using Terazosin is as follows:

• The initial dose of Terazosin is 1 mg daily at bedtime for 3 days, 2 mg at bedtime for 7 days, thereafter 5 mg at bedtime daily for 6 months 3
• Terazosin can be administered once daily due to its relatively long duration of action, offering a potential clinical advantage over other alpha 1-adrenoceptor antagonists 4
• The dose of Terazosin can be titrated from 2 to 20 mg nightly depending on improvement in symptoms and flow rate 5
• The most common final dose of Terazosin is 10 mg once daily 6

Efficacy of Terazosin in BPH

The efficacy of Terazosin in BPH is reflected in:

• Increases in peak urinary flow rate 3, 4, 5
• Reductions in obstructive and irritative symptom scores 3, 4, 5
• Reductions in residual urinary volume from baseline 3, 4, 5
• Improvements in International Prostate Symptom Score (IPSS) 3, 7

Safety of Terazosin in BPH

The safety of Terazosin in BPH is characterized by:

• Minimal side effects, which are generally mild or moderate in severity and resolve following cessation of therapy 6
• A low incidence of premature withdrawal due to side effects (9% of Terazosin-treated patients) 6
• No significant effect on blood pressure in normotensive patients, whereas patients with untreated hypertension had substantial decreases in both systolic and diastolic blood pressures 7, 6