Terazosin Uses and Applications

Terazosin is primarily used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and hypertension. 1, 2

Use in Benign Prostatic Hyperplasia (BPH)

Terazosin is an effective treatment option for men with symptomatic BPH through the following mechanisms:

Terazosin functions as an alpha-1 adrenergic receptor antagonist (alpha blocker) that inhibits alpha-1 adrenergic-mediated contraction of prostatic smooth muscle, thereby relieving bladder outlet obstruction 1
It relaxes smooth muscle in the prostate, prostatic capsule, proximal urethra, and bladder neck, reducing urethral pressure and bladder outlet resistance 3
Clinical improvements in BPH symptoms typically begin within 2-4 weeks of starting treatment 2, 3

Terazosin significantly improves BPH symptoms compared to placebo, producing on average a 4-6 point improvement in the AUA Symptom Index 1
It increases peak urinary flow rates by approximately 2.6-3.0 mL/sec over placebo 2
Specific symptoms improved include hesitancy, intermittency, impairment in size and force of urinary stream, sensation of incomplete emptying, terminal dribbling, daytime frequency, and nocturia 1
The American Urological Association (AUA) considers terazosin to have equal clinical effectiveness to other alpha blockers such as alfuzosin, doxazosin, and tamsulosin for BPH treatment 1

Terazosin is effective in treating essential hypertension by relaxing blood vessels, allowing blood to pass through them more easily 2
It produces clinically significant reductions in both systolic and diastolic blood pressure in hypertensive patients 4
In patients with concomitant BPH and hypertension, terazosin can effectively treat both conditions simultaneously 5

Terazosin is typically titrated to effect, with clinical data supporting efficacy and safety up to 10 mg daily 1
For BPH treatment, efficacy is dose-dependent—higher doses generally produce greater observed improvement 1
Once-daily administration is possible due to terazosin's relatively long duration of action, which offers a potential advantage over some other alpha-1 blockers 3

The most common adverse events with terazosin include orthostatic hypotension, dizziness, tiredness (asthenia), ejaculatory problems, and nasal congestion 1, 2
Caution is recommended at treatment initiation and when dosage adjustments are made due to increased risk of postural hypotension during these periods 3
In normotensive and controlled hypertensive patients, terazosin produces no clinically significant mean changes in blood pressure 4
Terazosin does not adversely affect patients already taking concomitant antihypertensive medications 4

Terazosin is not appropriate for men with LUTS who do not have evidence of prostatic enlargement 1
In men with hypertension and cardiac risk factors, using an alpha blocker like terazosin to manage LUTS should not be assumed to constitute optimal management of concomitant hypertension; separate management may be required 1
While medical therapies like terazosin are not as efficacious as surgical therapies for BPH, they may provide adequate symptom relief with fewer and less serious adverse events 1
Terazosin has been shown to be cost-effective compared to surgical interventions like transurethral resection of the prostate (TURP) for BPH treatment 6