What is terazosin (Benign Prostatic Hyperplasia (BPH) medication) used for?

Terazosin: Uses and Indications

Terazosin is primarily used to treat benign prostatic hyperplasia (BPH) and hypertension by relaxing smooth muscles in the prostate and blood vessels, improving urinary flow and lowering blood pressure. 1

Uses for Terazosin

Treatment of Benign Prostatic Hyperplasia (BPH)

• Terazosin is an alpha-1 adrenergic blocker that works by inhibiting alpha-1 adrenergic-mediated contraction of prostatic smooth muscle, relieving bladder outlet obstruction 2
• It helps relieve lower urinary tract symptoms (LUTS) secondary to BPH by relaxing the tightness of muscles in the prostate and at the opening of the bladder 1
• Approximately 70% of patients experience increased urinary flow and improved BPH symptoms when treated with terazosin 1
• Effects on BPH symptoms are typically noticeable within 2-4 weeks of starting treatment 1

Treatment of Hypertension

• Terazosin works by relaxing blood vessels so that blood passes through them more easily, which helps lower blood pressure 1
• It can be used alone or in combination with other antihypertensive agents such as diuretics or beta-blockers 1

Efficacy in BPH Treatment

• Meta-analyzed data shows terazosin is effective in partially relieving BPH symptoms, producing on average a 4-to-6 point improvement in the AUA Symptom Index 2
• Clinical studies demonstrate terazosin provides:
  • Increased peak urinary flow rate (average increase of 2 ml/s) 3
  • Decreased residual urine volume 3
  • Statistically significant improvement in both obstructive and irritative symptom scores 3
• In network meta-analyses, terazosin shows an improvement of -3.7 points in IPSS (International Prostate Symptom Score) compared to placebo 2

Dosing and Administration

• Efficacy is dose-dependent for terazosin—higher doses generally provide greater observed improvement 2
• Clinical data support the efficacy and safety of titrating patients up to 10 mg of terazosin 2
• Doses typically range from 2-20 mg taken at bedtime for BPH treatment 3

Safety Profile and Side Effects

• Primary adverse events reported with terazosin therapy include:
  • Orthostatic hypotension
  • Dizziness
  • Tiredness (asthenia)
  • Ejaculatory problems
  • Nasal congestion 2
• Side effects are generally mild, with low discontinuation rates due to adverse events 3, 4
• Blood pressure effects vary based on baseline status:
  • In hypertensive patients, terazosin produces clinically significant reductions in systolic and diastolic blood pressure 5
  • In normotensive and controlled hypertensive patients, terazosin produces no clinically significant mean changes in blood pressure 5

Special Considerations

• Terazosin can be safely used in BPH patients regardless of their blood pressure status and concurrent antihypertensive regimen 6
• Caution is recommended at treatment initiation and when dosage adjustments are made due to increased risk of postural hypotension 7
• Patients with planned cataract surgery should be informed of the risks of intraoperative floppy iris syndrome (IFIS) associated with alpha blockers 2
• In men with hypertension and cardiac risk factors, alpha blockers like terazosin should not necessarily be assumed to constitute optimal management of concomitant hypertension 2

Comparison to Other Alpha Blockers

• The American Urological Association guidelines state that alfuzosin, doxazosin, tamsulosin, and terazosin have equal clinical effectiveness for treating LUTS secondary to BPH 2
• There are slight differences in adverse event profiles between alpha blockers:
  • Tamsulosin appears to have a lower probability of orthostatic hypotension but a higher probability of ejaculatory dysfunction compared to terazosin and other alpha blockers 2
• The choice of alpha blocker should be based on patient age, comorbidities, and different adverse event profiles 2