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Autonomic Dysreflexia

Terazosin

Terazosin is a long-acting, alpha-1adrenoceptor selective blocking agent. Selective alpha 1 blockade has been suggested as a good pharmacological choice in the management of AD because of its dual effect at the bladder level (inhibition of urinary sphincter and relaxation of the smooth muscles of blood vessels).

Author Year; Country
Score
Research Design
Sample Size		 Methods Outcome

Vaidyanathan et al. 1998; UK
Pre-post
N=24

 Population: 18 adults with tetraplegia (17 male, 1 female), 3 children with ventilator-dependent tetraplegia and 3 adult males with paraplegia. All had AD in the absence of an acute factor.
Treatment: Administration of Terazosin with starting dose of 1 mg (adults) or 0.5 mg (children). Step-wise increments of these doses were given at 3-4 day intervals.
Outcome Measures: drug-induced hypotension, adverse effects, AD symptoms.
  1. The AD symptoms subsided completely with the Terazosin therapy in all the patients.
  2. Adult patients required a dose between 1-10 mg and children required between 1-2 mg.
  3. The side effects of postural hypotension and drowsiness were transient and mild. One tetraplegic patient developed persistent dizziness and therapy was discontinued.
Chancellor et al. 1994; USA
Pre-post
N=21		 Population: 21 subjects with complete SCI; injury level C3-T5.
Treatment: Terazosin administration.
Outcome Measures: blood pressure and autonomic dysreflexia frequency and severity scores
  1. Decrease in the AD severity score from baseline at one week, 1 month and 3 months.
  2. Degree of muscle spasm and degree of headache did not improve.
  3. Decrease in the frequency of AD at 1-week follow-up and was maintained at 1 and 3 months.
  4. SBP did not statistically change after 3 months of Terazosin.
Swierzewski et al. 1994; USA
Pre-post
N=12		 Population: 6 subjects with paraplegia, 6 with quadriplegia.
Treatment: nightly Terazosin administration for 4 weeks (5 mg starting dose).
Outcome Measures: physical examination, cystoscopy, AD symptoms.
  1. Detrusor compliance improved in all patients during the treatment phase.
  2. Change in bladder pressure and safe bladder volume were statistically and clinically significant.
  3. Terazosine abolished AD in 3 patients and decreased the incidence and the severity of symptoms in 1 patient.

Discussion

Regular doses of Terazosin over weeks or months were evaluated in three level 4 experimental studies (n=57) (Vaidyanathan et al. 1998; Swierzewski et al. 1994; Chancellor et al. 1994) in which it appears to be effective in preventing AD without erectile function impairment. Patients reported moderate to excellent improvement (Chancellor et al. 1994) or even complete termination of the dysreflexic symptoms (Vaidyanathan et al. 1998) during a 3-month period of Terazosin administration.

Conclusion

There is level 4 evidence (from 3 pre-post studies) (Vaidyanathan et al. 1998; Swierzewski et al. 1994; Chancellor et al. 1994) that regular use of Terazosin may have positive effects on both incontinence and AD.

There is limited evidence for the use of Terazosin as an agent for control of AD in SCI individuals.

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