Terazosin Dosage and Treatment Protocol for BPH and Hypertension
For patients with both benign prostatic hyperplasia (BPH) and hypertension, terazosin should be initiated at 1 mg at bedtime, with gradual titration to 10 mg once daily for optimal management of BPH symptoms, while additional antihypertensive therapy may be needed for adequate blood pressure control. 1
Dosing Protocol for Terazosin in BPH with Hypertension
Initial Dosing
- Start with 1 mg at bedtime for all patients
- This initial dose should not be exceeded to minimize risk of severe hypotensive response 1
- If terazosin administration is discontinued for several days, therapy should be reinitiated using the initial dosing regimen 1
Dose Titration for BPH
- Increase dose in a stepwise fashion: 1 mg → 2 mg → 5 mg → 10 mg once daily
- 10 mg daily is generally required for clinical response in BPH 1
- Treatment with 10 mg for 4-6 weeks minimum is needed to assess beneficial response 1
- Some patients may require up to 20 mg daily, though data supporting this dose is limited 1
Blood Pressure Monitoring
- Monitor blood pressure at the end of dosing interval
- Consider measuring blood pressure 2-3 hours after dosing to evaluate maximum and minimum responses 1
- Patients should be closely followed during initial administration to minimize risk of severe hypotensive response 1
Efficacy and Safety Considerations
Efficacy for BPH
- Alpha-blockers like terazosin produce on average a 4-6 point improvement in the AUA Symptom Index 2
- Terazosin increases peak urinary flow rate by approximately 2 ml/s 3
- Terazosin improves both obstructive and irritative symptoms 3, 4
Blood Pressure Effects
- In normotensive and controlled hypertensive patients, terazosin produces minimal reductions in blood pressure 5, 6
- In patients with untreated hypertension, terazosin produces substantial decreases in both systolic and diastolic blood pressure 5
- Terazosin can be safely administered to both normotensive and hypertensive patients with BPH 5, 6
Concomitant Medication Considerations
- Caution when administering with other antihypertensive agents, especially calcium channel blocker verapamil 1
- Dosage reduction and retitration of either terazosin or the other antihypertensive agent may be necessary 1
- Hypotension has been reported when terazosin is used with PDE-5 inhibitors 1
- Use of an alpha-blocker to manage LUTS should not be assumed to constitute optimal management of concomitant hypertension 2
Common Side Effects and Management
Primary Adverse Events
- Orthostatic hypotension
- Dizziness (most common symptom leading to withdrawal, 2.0%) 5
- Headache (1.1% withdrawal rate) 5
- Tiredness (asthenia)
- Ejaculatory problems
- Nasal congestion 2
Risk Mitigation
- Side effects are generally mild or moderate in severity and resolve following cessation of therapy 5
- Only 0.6% of patients experience syncopal episodes, typically at initiation of therapy or dose escalation 5
- Postural symptoms and dizziness may be slightly more common in patients ≥65 years old 5
Comparative Considerations
- Tamsulosin appears to have a lower probability of orthostatic hypotension but a higher probability of ejaculatory dysfunction than other alpha blockers 2, 7
- Alfuzosin has lower rates of ejaculatory dysfunction with similar efficacy to other alpha blockers 7
- Terazosin has lower rates of ejaculatory dysfunction but higher rates of orthostatic hypotension compared to selective alpha blockers 7
Clinical Pearls
- If blood pressure control is substantially diminished at 24 hours, consider an increased dose or twice daily regimen 1
- In hypertensive patients, additional antihypertensive agents (thiazide diuretics, long-acting calcium channel blockers, ACE inhibitors, or ARBs) may be needed for optimal blood pressure management 7
- Terazosin can positively affect lipid profiles, with increases in HDL to cholesterol ratio and reductions in total cholesterol, LDL, and triglycerides 5