What is the use of Terazosin (Hytrin)?

From the Guidelines

Terazosin is a recommended treatment option for patients with bothersome, moderate to severe lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH).

Key Points

• 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.
• Terazosin works by relaxing smooth muscles in the prostate, improving urine flow, and is typically started at 1 mg at bedtime, potentially increasing to 5-10 mg daily based on symptom improvement.
• Common side effects of terazosin include dizziness, headache, drowsiness, weakness, and nasal congestion, and it may interact with other blood pressure medications and erectile dysfunction drugs, potentially causing dangerous drops in blood pressure 1.

Treatment Considerations

• Patients should be informed about the potential side effects and interactions of terazosin, and should rise slowly from sitting or lying positions, especially when starting treatment.
• The medication should be taken consistently, preferably at bedtime to minimize side effects like dizziness and first-dose orthostatic hypotension.
• According to the AUA guideline, clinicians should offer one of the following alpha blockers, including terazosin, as a treatment option for patients with bothersome, moderate to severe LUTS/BPH 1.

Evidence Summary

• Multiple phase III randomized control trials, phase IV studies, systematic reviews, and meta-analyses have demonstrated the efficacy of alpha blockers, including terazosin, for LUTS and BPH since the 1980s 1.
• The AUA guideline recommends terazosin as a treatment option for LUTS/BPH, with a moderate recommendation and evidence level of Grade A 1.

From the FDA Drug Label

Terazosin Capsules are used to treat high blood pressure (hypertension). Terazosin Capsules are also used to treat benign prostatic hyperplasia (BPH) in men. Terazosin Capsules work by relaxing blood vessels so that blood passes through them more easily. Terazosin Capsules relax the tightness of a certain type of muscle in the prostate and at the opening of the bladder

The primary uses of Terazosin are to:

• Treat hypertension by relaxing blood vessels
• Treat benign prostatic hyperplasia (BPH) by relaxing muscles in the prostate and at the opening of the bladder 2 It is also indicated for the treatment of symptomatic BPH and hypertension 2

From the Research

Terazosin Overview

• Terazosin is a selective alpha 1-adrenoceptor antagonist used in the treatment of benign prostatic hyperplasia (BPH) and hypertension 3, 4, 5, 6, 7.
• It works by reducing urethral pressure, bladder outlet resistance, and urinary symptoms associated with symptomatic BPH 5.

Efficacy in BPH Treatment

• Terazosin has been shown to improve peak urinary flow rate and reduce obstructive and irritative symptom scores in patients with BPH 3, 5, 6, 7.
• Clinical improvements begin to occur within 2 weeks and have been sustained for up to 2 years 5.
• The most marked treatment effects tend to occur in patients with more severe pretreatment urinary flow abnormalities 5.

Safety and Tolerability

• Terazosin is generally well tolerated, but caution is recommended at treatment initiation and when dosage adjustments are made due to an increased risk of postural hypotension and related adverse effects 3, 5, 6.
• Common side effects include dizziness, headache, and urinary tract infection 3, 6.
• Terazosin can be safely administered to both normotensive and hypertensive patients with symptomatic BPH 3.

Dosage and Administration

• The recommended dosage of terazosin is 1-10 mg once daily, with the most common final dose being 10 mg once daily 3.
• The relatively long duration of action of terazosin allows for once-daily administration, offering a potential clinical advantage over other alpha 1-adrenoceptor antagonists 5.