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Tamsulosin vs Terazosin
Introduction
For patients with benign prostatic hyperplasia (BPH) or other types of urinary difficulties, certain drugs that relax the muscles in the prostate and bladder neck can help improve urination. Tamsulosin and Terazosin are two such drugs that are frequently prescribed for BPH. Both work by blocking alpha-adrenergic receptors in the smooth muscle tissue, thereby improving urine flow and reducing BPH symptoms. Tamsulosin is a selective alpha blocker primarily affecting α1A adrenergic receptor located mainly in vascular smooth muscle, prostate, and bladder. On the other hand, Terazosin is classified as a non-selective α1 antagonist influencing both α1A & α1B adrenergic receptors equally which results not only in relieving BPH symptoms but also helping reduce blood pressure.
Tamsulosin vs Terazosin Side By Side
| Attribute | Flomax | Hytrin |
|---|---|---|
| Brand Name | Flomax | Hytrin |
| Contraindications | Should not be taken with or shortly after stopping phosphodiesterase-5 (PDE5) inhibitors like Sildenafil. Sudden discontinuation can lead to a rapid increase in blood pressure. | Should not be taken with or shortly after stopping phosphodiesterase-5 (PDE5) inhibitors like Sildenafil. Sudden discontinuation can lead to a rapid increase in blood pressure. |
| Cost | For brand name, around $140 for 30 capsules. Generic versions cost between $0.10 and $0.40 per day. | For brand name, around $130 for 90 tablets. Generic versions cost between <$0.07/day and around $0.25/day. |
| Generic Name | Tamsulosin | Terazosin |
| Most Serious Side Effect | Severe allergic reactions, prolonged erection (priapism), severe dizziness or fainting due to orthostatic hypotension, abnormal heartbeat, severe headaches with blurred vision, signs of liver problems. | Allergic reactions, severe skin reactions, fainting due to sudden decrease in blood pressure, severe dizziness or vertigo, pounding heartbeats or fluttering in chest, vision changes, swelling in hands or feet. |
| Severe Drug Interactions | Phosphodiesterase-5 (PDE5) inhibitors like Sildenafil. | Phosphodiesterase-5 (PDE5) inhibitors like Sildenafil. |
| Typical Dose | Starts at 0.4 mg/day, can be increased to 0.8 mg/day if necessary. | Starts at 1 mg/day at bedtime, can be gradually increased to 2 mg, 5 mg, or up to 20 mg per day in divided doses. |
What is Tamsulosin?
Tamsulosin (the generic name for Flomax) was an important advancement in the class of alpha blockers. It was first approved by the FDA in 1997 and is primarily used to treat benign prostatic hyperplasia (BPH), a condition common in older men that results in an enlarged prostate gland. Tamsulosin works by relaxing the muscles around the bladder and prostate, making it easier to urinate. Unlike other drugs in its class, tamsulosin particularly affects receptors present on the smooth muscle cells of the prostate and bladder neck without dramatically affecting blood pressure levels.
On another hand, Terazosin has been available for much longer and while it also treats BPH symptoms effectively, it impacts more types of alpha-adrenergic receptors found throughout different parts of body including blood vessels causing significant drops in blood pressure especially upon standing or positional changes which can lead to dizziness or fainting. Therefore Tamsulosin tends to be better tolerated with fewer side effects than Terazosin due to its selectivity.
What conditions is Tamsulosin approved to treat?
Tamsulosin is approved for the treatment of varying conditions such as:
- Benign prostatic hyperplasia (BPH), also known as an enlarged prostate
- Difficulty in urinating due to BPH
On the other hand, Terazosin has a broader range of applications including:
- Hypertension, or high blood pressure
- BPH and associated urinary difficulties
How does Tamsulosin help with these illnesses?
Tamsulosin helps to manage symptoms of benign prostatic hyperplasia (BPH) by relaxing the muscles in the prostate and bladder neck, thereby making it easier to urinate. It does this by selectively blocking alpha-1 receptors, which are primarily located in these muscle tissues. When blocked, these receptors can no longer respond to signals that would normally cause muscular contraction, thus allowing for increased urinary flow.
Like Tamsulosin, Terazosin also treats BPH symptoms but it is less selective in its action on the body's alpha-1 receptors. This means while Terazosin also relaxes the muscles in the prostate and bladder neck aiding urination; its wider influence can lead to a greater likelihood of side effects such as dizziness or low blood pressure due to overall systemic vasodilation (widening of blood vessels). By directly comparing these two medications: Tamsulosin may present fewer side-effects but both effectively aid patients with BPH enhance their urinary function.
What is Terazosin?
Terazosin is a drug that belongs to the class of alpha-1 adrenergic blockers, meaning it works by blocking the action of adrenaline on specific sites in the body, particularly within the vascular smooth muscle and the prostate. Terazosin was first approved by the FDA for medical use in 1987. As terazosin does not act as an SSRI or any other type of antidepressant, it does not inhibit serotonin reuptake. Its lack of action on serotonin means that its side-effect profile is different from SSRIs like Prozac; specifically, it doesn't induce sedation nor lead to weight gain and sexual dysfunction (common side effects with SSRIs). The effect on alpha receptors can be beneficial for treating symptoms related to benign prostatic hyperplasia (BPH) and hypertension—especially among patients who do not respond well to 'typical' drugs prescribed for these conditions.
What conditions is Terazosin approved to treat?
Terazosin is approved for the management of:
- Hypertension, to help lower blood pressure
- Benign prostatic hyperplasia (BPH), also known as an enlarged prostate. This condition can cause problems with urination.
How does Terazosin help with these illnesses?
Terazosin is a drug that helps in the management of hypertension and benign prostatic hyperplasia (BPH) by relaxing certain muscles. Terazosin works as an alpha blocker, which means it decreases resistance to urinary flow and reduces muscle tone in the prostate gland and bladder neck. This can relieve symptoms such as poor urine stream or frequent need to urinate, especially during nighttime hours. Its role on blood vessels may also play a part in its action as an antihypertensive medication. Since it causes less sexual side effects compared to other BPH medications, Terazosin might be prescribed when a patient does not respond well to typical BPH drugs like Tamsulosin or when minimizing these side-effects is critical for the patient's quality of life.
How effective are both Tamsulosin and Terazosin?
Tamsulosin and terazosin are both frequently prescribed for the treatment of benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate, leading to urinary problems. Both drugs were approved by the FDA within a decade of each other, with terazosin in 1987 and tamsulosin in 1997.
A double-blind clinical trial conducted in 2003 compared these two medications directly. This study revealed no significant difference between tamsulosin and terazosin regarding efficacy or overall side effect profile in managing symptoms of BPH. However, tamsulosin did show less cardiovascular side effects like postural hypotension than terazosin, which may make it more favorable among patients at risk for cardiac issues.
A review from 2010 affirmed that both drugs were indeed effective at alleviating symptoms associated with BPH starting from the first week of treatment and had similar tolerability profiles across a wide range of patient populations. Tamsulosin has become one of the most widely used alpha-blockers globally due to its selectivity for alpha-1 receptors located primarily in the prostate gland.
Another meta-analysis published in 2006 indicated that while both medicines showed promising results against placebo controls, there was evidence suggesting tamsulosin might be slightly better tolerated as fewer patients stopped taking this medication due to adverse events compared to those on terazosine. Despite this finding, many medical professionals still consider either drug as suitable first-line treatments depending upon individual patient characteristics and needs.
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At what dose is Tamsulosin typically prescribed?
Oral dosages of Tamsulosin typically start at 0.4 mg/day, and this has been found to be effective in treating benign prostatic hyperplasia (BPH) symptoms in most men. If there is no response after two to four weeks, the dosage can be increased to 0.8 mg/day. Terazosin starts at a lower dose of 1 mg/day, which can be gradually increased over several weeks up to a maximum of 20 mg/day as needed for desired symptom relief from BPH or hypertension. It's important that these medications are taken exactly as prescribed by your health care provider, and regular follow-up appointments will determine if any adjustments need to be made.
At what dose is Terazosin typically prescribed?
Terazosin therapy typically starts at a dose of 1 mg/day taken at bedtime to reduce the chance of fainting after taking the first dose. Depending on patient response and tolerance, the dosage can be gradually increased to 2 mg, 5 mg, or even up to a maximum of 20 mg per day taken in divided doses. It's important for patients starting terazosin treatment to have their blood pressure monitored closely during this period. If there is no improvement in symptoms after several weeks, your healthcare provider may suggest an increase in dosage or a different course of treatment altogether.
What are the most common side effects for Tamsulosin?
Common side effects of Tamsulosin can include:
- Dizziness, particularly when standing up from a sitting or lying position
- Unusual tiredness or weakness (asthenia)
- Difficulty sleeping (insomnia)
- Headache
- Runny or stuffy nose, sinus congestion (sinusitis)
- Decreased sex drive and abnormal ejaculation
- Nausea
- Back pain
On the other hand, Terazosin may cause:
- Lightheadedness and dizziness upon standing up too quickly due to blood pressure drop (orthostatic hypotension)
- Weakness and fatigue
- Nasal congestion
- Nausea
-Drowsiness/Sleepiness (somnolence)
-Fainting spells, -Swelling in the extremities.
Always consult your healthcare provider if you experience any unusual symptoms while taking these medications.
Are there any potential serious side effects for Tamsulosin?
While both Tamsulosin and Terazosin are generally safe, they can occasionally lead to serious side effects. In rare cases, these may include:
- A severe allergic reaction manifested by difficulty breathing; swelling of the face, lips, tongue or throat; hives
- Prolonged erection that lasts more than four hours (priapism), which if left untreated can cause permanent damage to your penis
- Orthostatic hypotension - a sudden drop in blood pressure when standing up from sitting or lying down position resulting in dizziness or fainting;
- Abnormal heartbeat patterns or a racing heart rate
- Severe headaches accompanied by blurred vision
- Any signs of liver problems such as yellow eyes/skin, dark urine, persistent nausea/vomiting.
You should immediately stop taking either medication and seek medical attention if you experience any of these symptoms.
What are the most common side effects for Terazosin?
Common side effects of Terazosin include:
- Dizziness or lightheadedness, especially when getting up from a lying or sitting position
- Headache
- Unusual tiredness or weakness
- Nasal congestion
- Nausea
- Swelling of the hands, feet, ankles, or lower legs
- Blurred vision
- Rapid heartbeat (tachycardia) You may also experience decreased sexual ability and difficulty in achieving an erection. Remember that while these potential side effects may seem daunting, they do not affect every individual who takes Terazosin. Always consult with your healthcare provider about any concerns you have regarding medication.
Are there any potential serious side effects for Terazosin?
While Terazosin is generally well-tolerated, it can have potential side effects in rare cases. It's important to contact a healthcare professional if you experience any of the following:
- Signs of an allergic reaction: hives, difficulty breathing, swelling in your face or throat
- A severe skin reaction: fever, sore throat, burning eyes, skin pain; red or purple rash that spreads and causes blistering and peeling.
- Lightheadedness leading to fainting (due to sudden decrease in blood pressure)
- Severe dizziness or spinning sensation (vertigo)
- Pounding heartbeats or fluttering in your chest
- Vision changes such as blurred vision
- Swelling in hands or feet
If you notice these symptoms while taking Terazosin, seek medical advice promptly.
Contraindications for Tamsulosin and Terazosin?
Both Tamsulosin and Terazosin, like most other alpha-blocker medications, may cause certain side effects such as dizziness or lightheadedness. If you notice these symptoms getting worse, or if you experience fainting spells, seek immediate medical attention.
Neither Tamsulosin nor Terazosin should be taken if you are currently using or have recently stopped using phosphodiesterase-5 (PDE5) inhibitors like Sildenafil. Always inform your physician about all the medications that you are taking; PDE5 inhibitors will require some time to clear from the system to prevent potentially harmful interactions with both Tamsulosin and Terazosin.
Furthermore, sudden discontinuation of either medication can lead to a rapid increase in blood pressure. Therefore it is important that any changes in the dosage or cessation of use should only occur under direct supervision by a healthcare professional.
How much do Tamsulosin and Terazosin cost?
For the brand name versions of these drugs:
- The price for 30 capsules of Flomax (tamsulosin 0.4 mg) averages around $140, which works out to about $4.70/day.
- The price for 90 tablets of Hytrin (terazosin 1 mg) is approximately $130, resulting in a daily cost of roughly $1.45.
Thus, if you are prescribed tamsulosin, then brand-name terazosin (Hytrin) is less expensive on a per-day treatment basis. However, it's worth mentioning that cost should not be your primary consideration when deciding which drug to take; effectiveness and safety are paramount.
Regarding generic versions -
- Tamsulosin can be bought as packs ranging from 30 capsules upwards with approximate costs between $0.10 and $0.40 per day depending on the dosage.
- Terazosin also comes in packs starting at 15 up to several hundreds tablets with the cost typically falling between <$0.07/day and around $0.25/day.
In general terms, both generics present significantly lower prices than their branded counterparts while maintaining similar efficacy levels.
Popularity of Tamsulosin and Terazosin
Tamsulosin, available as a generic and under the brand name Flomax, was prescribed to approximately 8.2 million people in the US in 2020. Tamsulosin accounted for about 27% of prescriptions for benign prostatic hyperplasia (BPH) medications in the US. As an alpha blocker that is selective for the type of receptors found predominantly in the prostate, it has fewer cardiovascular side effects than non-selective alpha blockers such as terazosin.
Terazosin, both generic and brand-name versions like Hytrin, was prescribed to about 1.7 million people in America during the same year. In terms of overall BPH medication prescriptions within the nation, terazosin represents nearly 5%. While its usage has been declining over time due to more targeted therapies becoming available like tamsulosin and because it can cause marked dizziness upon standing up (orthostatic hypotension), it is often chosen when co-treatment of high blood pressure is desirable due to its ability to relax vascular smooth muscle.
Conclusion
Both Tamsulosin and Terazosin have well-established efficacy in managing symptoms of benign prostatic hyperplasia (BPH), with multiple studies and clinical trials supporting their effectiveness over placebo. In certain situations, these drugs may be used together, but this requires careful evaluation by a physician due to potential interactions. Their mechanisms of action are different; Tamsulosin is an alpha-1A adrenergic receptor blocker primarily affecting the prostate gland while Terazosin is a non-selective alpha-1 adrenergic receptor antagonist also influencing vascular smooth muscle.
Tamsulosin is often considered as the first-line treatment option for BPH due to its specificity for the prostate gland whereas Terazosin might be chosen if there's concurrent hypertension that needs management, or when cost considerations come into play since it's available in generic form at lower costs than tamsulosin.
There could be an adjustment period before patients see improvements in their symptoms with either drug. Side effects can vary between these drugs but both are generally well-tolerated. However, terazosin has been associated more frequently with hypotension upon standing up too quickly from lying down position compared to tamsulosin. It’s critical that patients monitor their responses closely when starting treatment and seek immediate medical attention if they experience severe side effects such as extreme dizziness or fainting.
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Refrences
- Wilde, M. I., & McTavish, D. (1996, December). Tamsulosin. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-199652060-00012
- Wilde, M. I., Fitton, A., & Sorkin, E. M. (1993). Terazosin. Drugs & Aging. Springer Science and Business Media LLC.http://doi.org/10.2165/00002512-199303030-00007
- Tsujii, T. (2000, June). Comparison of prazosin, terazosin and tamsulosin in the treatment of symptomatic benign prostatic hyperplasia: A short‐term open, randomized multicenter study. International Journal of Urology. Wiley.http://doi.org/10.1046/j.1442-2042.2000.00175.x
- Schäfers, R. F., Fokuhl, B., Wasmuth, A., Schumacher, H., Taguchi, K., De Mey, C., … Michel, M. C. (1999, January). Differential vascular <i>α</i><sub>1</sub>‐adrenoceptor antagonism by tamsulosin and terazosin. British Journal of Clinical Pharmacology. Wiley.http://doi.org/10.1046/j.1365-2125.1999.00856.x
- Achari, R., Hosmane, B., Linnen, P., Cavanaugh, J., Baroldi, P., & Cohen, A. (1998, June). Effects of Oral and Intravenous Terazosin and Head‐up Tilt on Blood Pressure Responses in Patients with Hypertension. The Journal of Clinical Pharmacology. Wiley.http://doi.org/10.1002/j.1552-4604.1998.tb05793.x
- Harada, K., Ohmori, M., Kitoh, Y., Sugimoto, K.-. ichi ., & Fujimura, A. (1999). A Comparison of the Antagonistic Activities of Tamsulosin and Terazosin Against Human Vascular α1Adrenoceptors. Japanese Journal of Pharmacology. Elsevier BV.http://doi.org/10.1254/jjp.80.209