TERAZOSIN — terazosin hydrochloride capsule
State of Florida DOH Central Pharmacy
Terazosin hydrochloride, an alpha-1-selective adrenoceptor blocking agent, is a quinazoline derivative represented by the following chemical name,molecular formula and structural formula:(RS)-Piperazine, 1-(4-amino-6,7-dimethoxy-2-quinazolinyl)-4-[(tetrahydro-2-furanyl)carbonyl]-, monohydrochloride.C19 H26 ClN5 O4
Terazosin hydrochloride is a white, crystalline substance, freely soluble in water and isotonic saline and has a molecular weight of 423.93. Each capsule, for oral administration, contains 1 mg, 2 mg, 5 mg or 10 mg of terazosin as terazosin hydrochlolde. In addition, each capsule contains the following inactive ingredients: colloidal silicon dioxide, lactose monohydrate, magnesium stearate, and pregelatinized starch. The gelatin capsule contains gelatin, silicon dioxide, sodium lauryl sulfate, and titanium dioxide. The 1 mg shell also contains black iron oxide; the 2 mg capsule shell also contains D&C Yellow #10; the 5 mg capsule shell also contains D&C Yellow #10, FD&C Red #40 and D&C Red #28; the 10 mg capsule shell also contains FD&C Green #3 and D&C Yellow#10.
The symptoms associated with BPH are related to bladder outlet obstruction, which is comprised of two underlying components: a static component and a dynamic component. The static component is a consequence of an increase in prostate size. Over time, the prostate will continue to enlarge. However, clinical studies have demonstrated that the size of the prostate does not correlate with the severity of BPH symptoms or the degree of urinary obstruction. The dynamic component is a function of an increase in smooth muscle tone in the prostate and bladder neck, leading to constriction of the bladder outlet. Smooth muscle tone is mediated by sympathetic nervous stimulation of alpha-1 adrenoceptors, which are abundant in the prostate, prostatic capsule and bladder neck. The reduction in symptoms and improvement in urine flow rates following administration of terazosin is related to relaxation of smooth muscle produced by blockade of alpha-1 adrenoceptors in the bladder neck and prostate. Because there are relatively few alpha-1 adrenoceptors in the bladder body, terazosin is able to reduce the bladder outlet obstruction without affecting bladder contractility.
Terazosin has been studied in 1222 men with symptomatic BPH. In three placebo-controlled studies, symptom evaluation and uroflowmetric measurements were performed approximately 24 hours following dosing. Symptoms were quantified using the Boyarsky Index. The questionnaire evaluated both obstructive (hesitancy, intermittency, terminal dribbling, impairment of size and force of stream, sensation of incomplete bladder emptying) and irritative (nocturia, daytime frequency, urgency, dysuria) symptoms by rating each of the 9 symptoms from 0 to 3, for a total score of 27 points. Results from these studies indicated that terazosin statistically significantly improved symptoms and peak urine flow rates over placebo as follows:
|Symptom Score||Change %||Peak Flow Rate||Change %|
|Study 1 (10 mg)a|
|Titration to fixed dose (12 wks)|
|Placebo||55||9.7||-2.3 (24)||54||10.1||+1.0 (10)|
|Terazosin||54||10.1||-4.5 (45)*||52||8.8||+3.0 (34)*|
|Study 2 (2, 5, 10, 20 mg)b|
|Titration to Response (24 wks)|
|Placebo||89||12.5||-3.8 (30)||88||8.8||+1.4 (16)|
|Terazosin||85||12.2||-5.3 (43)*||84||8.4||+2.9 (35)*|
|Study 3 (1, 2, 5, 10 mg)c|
|Titration to response (24 wks)|
|Placebo||74||10.4||-1.1 (11)||74||8.8||+1.2 (14)|
|Terazosin||73||10.9||-4.6 (42)*||73||8.6||+2.6 (30)*|
a Highest dose 10 mg shown.
b 23% of patients on 10mg, 41% of patients on 20 mg.
c 67% of patients on 10 mg.* Significantly (p ≤ 0.05) more improvement than placebo.
In all three studies, both symptom scores and peak urine flow rates showed statistically significant improvement from baseline in patients treated with terazosin capsules from week 2 (or the first clinic visit) and throughout the study duration.
Analysis of the effect of terazosin capsules on individual urinary symptoms demonstrated that compared to placebo, terazosin significantly improved the symptoms of hesitancy, intermittency, impairment in size and force of urinary stream, sensation of incomplete emptying, terminal dribbling, daytime frequency and nocturia.
Global assessments of overall urinary function and symptoms were also performed by investigators who were blinded to patient treatment assignment. In studies 1 and 3, patients treated with terazosin had a significantly (p ≤ 0.001) greater overall improvement compared to placebo treated patients.
In a short term study (Study 1), patients were randomized to either 2, 5 or 10 mg of terazosin or placebo. Patients randomized to the 10 mg group achieved a statistically significant response in both symptoms and peak flow rate compared to placebo (Figure 1).
FIGURE 1., STUDY 1
† for baseline values see above table
* p ≤ 0.05, compared to placebo group
In a long-term, open-label, non-placebo controlled clinical trial, 181 men were followed for 2 years and 58 of these men were followed for 30 months. The effect of terazosin on urinary symptom scores and peak flow rates was maintained throughout the study duration (Figures 2 and 3):
Mean Change in Total Symptom Score from Baseline Long-Term, Open-Label, Non-Placebo Controlled Study (N=494)
*p ≤ 0.05 vs. baseline mean baseline = 10.7
FIGURE 3. Mean Change in Peak Flow Rate from Baseline Long-Term, Open-Label, Non-Placebo Controlled Study (N=494)
*p ≤ 0.05 vs. baseline; mean baseline = 9.9
In this long-term trial, both symptom scores and peak urinary flow rates showed statistically significant improvement suggesting a relaxation of smooth muscle cells.
Although blockade of alpha-1 adrenoceptors also lowers blood pressure in hypertensive patients with increased peripheral vascular resistance, terazosin treatment of normotensive men with BPH did not result in a clinically significant blood pressure lowering effect:
|Group||Normotensive Patients DBP ≤ 90 mm Hg||Hypertensive Patients DBP > 90 mm Hg|
|N||Mean Change||N||Mean Change|
|SBP (mm Hg)||Placebo Terazosin||293 519||-0.1 -3.3*||45 65||-5.8 -14.4*|
|DBP (mm Hg)||Placebo Terazosin||293 519||+0.4 -2.2*||45 65||-7.1 -15.1*|
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