Hypertension:
Note: Current pediatric blood pressure guidelines do not include terazosin for the management of pediatric hypertension; other agents are preferred (Ref).
Children and Adolescents: Limited data available: Oral: Initial: 1 mg once daily typically administered at bedtime; slowly increase dose to achieve desired blood pressure as tolerated; maximum daily dose: 20 mg/day (Ref). Note: If drug is discontinued for longer than several days, consider beginning with initial dose and retitrate as needed due to risk of postural hypotension and syncope.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Altered kidney function: There are no pediatric-specific dosage recommendations. Based on experience in adult patients, no dosage adjustment is likely necessary.
Hemodialysis: Based on adult information, 10% dialyzable; supplemental dose not necessary.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Terazosin: Drug information")
Note: If therapy is discontinued for several days or more, consider beginning with initial dose and retitrate as needed, due to risk of orthostatic hypotension.
Benign prostatic hyperplasia (monotherapy or combination therapy):
Note : In patients with moderate to severe predominant storage lower urinary tract symptoms, use in combination with beta-3 agonist or anticholinergic agent. In patients with a significantly enlarged prostate (prostate volume >30 mL, prostate-specific antigen >1.5 ng/mL, or palpable prostate enlargement on digital rectal exam), use in combination with 5-alpha reductase inhibitor (Ref).
Oral: Initial: 1 mg once daily at bedtime; titrate slowly every few weeks (eg, to 2 mg, then 5 mg, then 10 mg) based on response and tolerability; usual dose: 10 mg once daily; if no response after 4 to 6 weeks of 10 mg once daily, may increase to a maximum dose of 20 mg once daily.
Hypertension (alternative agent):
Note: Not recommended for initial management, but may be considered as additional therapy for resistant hypertension in patients who do not respond adequately to combination therapy with preferred agents (Ref).
Oral: Initial: 1 mg once daily; titrate gradually, as needed, based on response and tolerability up to 20 mg/day in 1 or 2 divided doses (Ref). Note: Administration at bedtime may help limit orthostasis.
Ureteral stone(s) expulsion (off-label use):
Note: Consider for use in patients with ureteral stones >5 and ≤10 mm (Ref). Although most evidence exists for distal ureteral stones, given the low side effect profile of alpha-blockers, may consider use in patients with stones in any location of ureter (Ref). Additionally, may consider for use after shock wave lithotripsy to help pass stone fragments (Ref). A uroselective alpha blocker (eg, tamsulosin) may be preferred to decrease risk of hypotension (Ref).
Oral: 2 to 5 mg once daily at bedtime until stone passage or for up to 4 weeks (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (Ref).
Hemodialysis, intermittent (thrice weekly): Dialyzable (~10%) (Ref): No supplemental dose or dosage adjustment necessary (Ref).
Peritoneal dialysis: Unlikely to be significantly dialyzed (highly protein bound): No dosage adjustment necessary (Ref).
CRRT: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults.
>10%: Nervous system: Asthenia (≤11%), dizziness (9% to 19%), fatigue (≤11%), lassitude (≤11%)
1% to 10%:
Cardiovascular: Orthostatic hypotension (1% to 5%), palpitations (4%), peripheral edema (6%), tachycardia (2%)
Gastrointestinal: Nausea (2% to 4%)
Genitourinary: Impotence (2%)
Nervous system: Drowsiness (4% to 5%), paresthesia (3%), vertigo (1%)
Neuromuscular & skeletal: Back pain (2%), limb pain (4%)
Ophthalmic: Amblyopia (≤1%), blurred vision (≤2%)
Respiratory: Dyspnea (2% to 3%), nasal congestion (≤6%), rhinitis (≤2%), sinusitis (3%)
<1%:
Cardiovascular: Syncope
Endocrine & metabolic: Weight gain
Frequency not defined:
Nervous system: Headache
Miscellaneous: Fever
Postmarketing:
Cardiovascular: Atrial fibrillation
Dermatologic: Acute generalized exanthematous pustulosis (Speck 2008), lichenoid eruption (Koh 2008)
Genitourinary: Priapism
Hematologic & oncologic: Thrombocytopenia
Hypersensitivity: Anaphylaxis, hypersensitivity reaction
Ophthalmic: Intraoperative floppy iris syndrome (Venkatesh 2007)
Hypersensitivity to terazosin or any component of the formulation
Concerns related to adverse effects:
• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).
• Floppy iris syndrome: Intraoperative floppy iris syndrome has been observed in cataract surgery patients who were on or were previously treated with alpha1-blockers; there appears to be no benefit in discontinuing alpha-blocker therapy prior to surgery. May require modifications to surgical technique.
• Orthostatic hypotension/syncope: May cause significant orthostatic hypotension and syncope, especially with first dose or first few days of therapy; anticipate a similar effect if therapy is interrupted for a few days, if dosage is rapidly increased, or if another antihypertensive drug (particularly vasodilators) or a PDE-5 inhibitor is introduced.
• Priapism: Priapism has been associated with use (rarely); seek immediate medical assistance for erections lasting longer than 4 hours.
Disease-related concerns:
• Heart failure: In a scientific statement from the American Heart Association, terazosin has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: moderate) (AHA [Page 2016]).
Other warning/precautions:
• Appropriate use: BPH: Rule out prostatic carcinoma before beginning therapy (many symptoms of BPH and prostate cancer are similar).
Tezruly 1 mg/mL oral solution: FDA approved July 2024; anticipated availability currently unknown. Information pertaining to this product within the monograph is pending revision. Tezruly is indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia and management of hypertension. Consult the prescribing information for additional information.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Generic: 1 mg, 2 mg, 5 mg, 10 mg
Solution, Oral, as hydrochloride:
Tezruly: 1 mg/mL (150 mL) [contains methylparaben, propylparaben; cherry flavor]
May be product dependent
Capsules (Terazosin HCl Oral)
1 mg (per each): $1.61
2 mg (per each): $1.61
5 mg (per each): $1.61
10 mg (per each): $1.61
Solution (Tezruly Oral)
1 mg/mL (per mL): $3.86
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Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Generic: 1 mg, 2 mg, 5 mg, 10 mg
Oral: Administer without regard to meals at the same time each day.
Oral: Administer at the same time each day.
Store at 20°C to 25°C (68°F to 77°F); protect from light and moisture.
Treatment of benign prostate hyperplasia (BPH) (FDA approved in adults); treatment of hypertension alone or in combination with other agents, such as diuretics or beta-blockers (FDA approved in adults).
Beers Criteria: Terazosin is identified in the Beers Criteria as a potentially inappropriate medication in patients 65 years and older due to its high risk of orthostatic hypotension. Avoid use for hypertension treatment (alternative agents have superior risk:benefit profiles) (Beers Criteria [AGS 2023]).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Alpha-/Beta-Agonists: Alpha1-Blockers may decrease therapeutic effects of Alpha-/Beta-Agonists. Risk C: Monitor
Alpha1-Blockers: May increase antihypertensive effects of Alpha1-Blockers. Risk X: Avoid
Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification
Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Antihypertensive Agents: May increase hypotensive effects of Terazosin. Risk C: Monitor
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor
Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor
Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid
Dapoxetine: May increase orthostatic hypotensive effects of Alpha1-Blockers. Risk C: Monitor
Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor
Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor
Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor
Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor
Levomethadone: May increase hypotensive effects of Alpha1-Blockers (Nonselective). Risk C: Monitor
Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor
Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Midodrine: Alpha1-Blockers (Nonselective) may decrease therapeutic effects of Midodrine. Risk C: Monitor
Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor
Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification
Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Phenylephrine (Systemic): Alpha1-Blockers may decrease vasoconstricting effects of Phenylephrine (Systemic). Risk C: Monitor
Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor
Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Alpha1-Blockers (Nonselective). Management: Ensure patient is stable on one agent prior to initiating the other, and always initiate combination using the lowest possible dose of the drug being added. When tadalafil is used for treatment of BPH, concurrent alpha 1-blockers are not recommended. Risk D: Consider Therapy Modification
Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Rilmenidine: Alpha1-Blockers may increase hypotensive effects of Rilmenidine. Risk C: Monitor
Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be continued in patients trying to conceive. Terazosin is not considered a preferred agent for use in pregnant patients; consider transitioning to a preferred agent in patients planning to become pregnant (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019).
Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).
Patients with preexisting hypertension may continue their medication during pregnancy unless contraindications exist (ESC [Regitz-Zagrosek 2018]). When treatment of chronic hypertension during pregnancy is indicated, agents other than terazosin may be preferred (ACOG 2019; ESC [Cífková 2020]; ESC [Regitz-Zagrosek 2018]; SOGC [Magee 2022]).
Although alpha-blockers may be used to facilitate ureteral stone expulsion, treatments other than terazosin are preferred if stone removal is needed during pregnancy (AUA/ES [Assimos 2016a]; Juliebø-Jones 2022; Lee 2021; Lloyd 2016).
Standing and sitting/supine blood pressure, especially 2 to 3 hours after the initial dose, then regularly during therapy.
Alpha1-specific blocking agent with minimal alpha2 effects; this allows peripheral postsynaptic blockade, with the resultant decrease in arterial tone, while preserving the negative feedback loop which is mediated by the peripheral presynaptic alpha2-receptors; terazosin relaxes the smooth muscle of the bladder neck, thus reducing bladder outlet obstruction
Onset of action: Antihypertensive effect: 15 minutes; Peak effect: Antihypertensive effect: 2 to 3 hours
Duration of action: Antihypertensive effect: 24 hours
Absorption: Rapid and complete
Protein binding: 90% to 94%
Metabolism: Hepatic; minimal first-pass
Half-life elimination: ~12 hours
Time to peak, plasma: ~1 hour; delayed ~40 minutes with food
Excretion: Feces (~60%, ~20% as unchanged drug); urine (~40%, ~10% as unchanged drug)
Older adult: Plasma clearance was decreased by 31.7% and half-life was 14 hours in patients ≥70 years.