Prazosin Has Not Been Recalled
Prazosin remains available on the market and has not been recalled, but it is not recommended for BPH treatment due to insufficient clinical evidence supporting its effectiveness. 1
Current Status and Guideline Recommendations
The American Urological Association does not recommend prazosin for treating BPH symptoms because there is inadequate data supporting its effectiveness, and its initial effects may diminish due to physiological tolerance development and/or progression of the underlying condition. 1
For BPH treatment, current guidelines recommend alfuzosin, doxazosin, tamsulosin, or terazosin instead of prazosin due to their more robust clinical evidence base. 2, 1
Why Prazosin Is Not Preferred
Insufficient Evidence Base
While older research from the 1990s showed prazosin could relieve obstructive and irritative BPH symptoms in 60-70% of patients at doses ranging from 1-9 mg daily 3, the maximum tolerable and effective doses have never been clearly defined. 1
Comparative studies demonstrate that terazosin produces significantly higher improvement in individual BPH symptoms compared to prazosin and tamsulosin. 4
Limitations Compared to Other Alpha Blockers
Other alpha blockers (alfuzosin, doxazosin, tamsulosin, terazosin) have undergone more extensive clinical trials and have stronger evidence supporting their long-term efficacy. 1
The combination of doxazosin and finasteride is the best-tested combination therapy, reducing the overall risk of BPH progression by 67%, risk of acute urinary retention by 79%, and risk of surgery by 67%. 2
Clinical Implications for Practice
For BPH Management
If a patient is currently on prazosin for BPH and effectiveness diminishes, switch to another alpha blocker with better evidence (alfuzosin, doxazosin, tamsulosin, or terazosin). 1
For patients with larger prostates (higher baseline PSA values), consider adding a 5-alpha-reductase inhibitor, as alpha blockers alone do not reduce prostate size or alter natural BPH progression. 2, 1
For Hypertension with Coexisting BPH
Prazosin remains a valid option for hypertension treatment, and approximately 30% of men treated for BPH have coexisting hypertension. 5
However, terazosin or doxazosin are preferable choices as they effectively treat both conditions simultaneously with stronger evidence for BPH efficacy. 5, 6
Tamsulosin is safer for elderly patients or those with impaired blood pressure regulation, as it produces minimal blood pressure changes compared to prazosin or terazosin. 4
Common Pitfall to Avoid
Do not assume prazosin is equivalent to other alpha blockers for BPH treatment simply because it shares the same mechanism of action—the clinical evidence supporting its use is substantially weaker than for newer agents, and guideline bodies have specifically excluded it from their recommendations. 1