Terazosin Finasteride

Prazosin (Minipress) Alfuzosin (Uroxatral) Terazosin (Hytrin) Doxazosin (Cardura) Tamsulosin (Flomax) Finasteride (Proscar) Dutasteride (Avodart) Bicalutamide (Casodex) Flutamide (Eulexin) Leuprolide (Lupron) Nafarelin (Synarel) Megestrol acetate... 

Geriatric Considerations - Summary Alpha-adrenergic blockers are modestly effective alone, and in combination with 5-alpha reductase inhibitors (e,g, finasteride) in the treatment of urinary obstructive symptoms related to benign prostatic hyperplasia. Alfuzosin is a "uroselective" alpha-blockerwhich appears to cause less orthostatic hypotension than nonselective alpha-blockers such as terazosin, prazosin, and doxazosin. 

Lepor H, Williford WO, Barry MJ, et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl I Med 1996 335 533-539. 

Pharmaceutical treatments for this common but annoying condition include finasteride (trade name Proscar) and terazosin (trade name Hytrin). Surgical procedures include the TURP procedure (transurethral resection of the prostate) and balloon dilation. 

A recent study by Bach, Schmitt, and Ebeling compared three prescriptive medications with a standardized saw palmetto extract. The drugs worked by two different mechanisms. Finasteride is a synthetic 5-alpha-reductase inhibitor, and the other two drugs, terazosin and alfuzosin, are alpha-1 blockers. In all important parameters, the saw palmetto was a comparable treatment with far fewer side effects. It decreased residual urine volume, reduced irritation, and increased urinary flow 80 percent of patients rated their improved quality of life as good to very good. 

Because finasteride and dutasteride are metabolized primarily by CYP3A4, the CYP3A4 inhibitors, such as ritonavir, ketoconazole, verapamil, diltiazem, cimetidine, and ciprofloxacin, may increase the drugs blood levels and, possibly, cause drug-drug interactions. Clinical drug interaction studies have shown no pharmacokinetic or pharmacodynamic interactions between dutasteride and tamsulosin or terazosin, warfarin, digoxin, and cholestyramine. 

No clinically important interaction has been found to occur between finasteride and doxazosin. In one study terazosin did not interact with finasteride, but in another there was a suggestion of modestly increased finasteride levels. No clinically significant interaction appears to occur between dutasteride and tamsuiosin or terazosin. 

Samara E, Hosmane B, Locke C, Eason C, Cavanaugh J, Graraieman GR Assessment of the pharmacokinetic-pharmacocfynamic interaction between terazosin and finasteride. J Clin Pharmacol (199Q 36,1169-78. 

Vashi V, Chung M, Hilbert J, Lawrence V, Phillips K. Pharmacokinetic interaction between finasteride and terazosin, but not finasteride and doxazosin. J Clin Pharmacol (1998) 38, 1072-6. 

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