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 |
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. |
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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 |
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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. |
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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.