Terazosin for Night Sweating
Terazosin is not indicated for the treatment of night sweats and should not be used for this purpose. There is no evidence supporting its efficacy for night sweating, and its use would expose patients to unnecessary cardiovascular and other adverse effects without therapeutic benefit.
Why Terazosin Is Not Appropriate for Night Sweats
Established Indications Only
- Terazosin is an alpha-1 adrenergic receptor antagonist approved exclusively for treating hypertension and benign prostatic hyperplasia (BPH), not for night sweats or any sweating disorder 1, 2, 3.
- The drug works by blocking alpha-1 receptors in vascular smooth muscle and the prostate, mechanisms unrelated to thermoregulation or sweating 4.
Significant Adverse Effect Profile
- Orthostatic hypotension is the most clinically significant adverse effect, occurring frequently with terazosin and requiring careful dose titration starting at 1 mg daily 5, 4.
- Common side effects include dizziness (14.6-20%), headache, asthenia (tiredness/weakness), and nasal congestion—all of which would represent unnecessary risks when treating night sweats 5, 6.
- In patients with hypertension and cardiac risk factors, alpha-blockers like terazosin have been associated with higher incidence of congestive heart failure compared to other antihypertensive agents 1.
Confusion with Prazosin
- You may be confusing terazosin with prazosin, a different alpha-1 blocker that has demonstrated efficacy for PTSD-associated nightmares and night sweats 7.
- Prazosin reduced nightmare frequency and severity in multiple randomized controlled trials of veterans with PTSD, with mean doses of 9.5-13 mg/day 7.
- While both are alpha-1 blockers, prazosin's efficacy for nightmares relates to reducing CNS sympathetic outflow and modulating sleep phenomena regulated by alpha-1 receptors—effects specific to prazosin's CNS penetration profile 7.
Critical Clinical Pitfall to Avoid
- Do not substitute terazosin for prazosin when treating night sweats or nightmares, as these are distinct medications with different pharmacokinetic profiles and clinical applications 7, 4.
- If night sweats are the primary concern, investigate the underlying cause (malignancy, infection, endocrine disorders, medications) rather than attempting symptomatic treatment with an inappropriate agent 7.
When Alpha-Blockers Are Appropriate
- Consider prazosin (not terazosin) specifically for PTSD-associated nightmares and night sweats, starting at low doses and titrating to effect 7.
- Use terazosin only for its approved indications: hypertension (though not as first-line) or symptomatic BPH, particularly in men with both conditions 7, 1, 2.