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doxazosin (Cardura)
Tradename: Cardura. An alpha-1 adrenergic receptor antagonist.
Indications:
- benign prostatic hypertrophy (BPH)
- hypertension
- urinary calculus [4]
* ok for treatment of hypertension with comorbid BPH in the elderly despite results of ALLHAT study [6]
Contraindications:
1) congestive heart failure
2) orthostatic hypotension
Dosage: start 1 mg PO QD, max 16 mg/day
Tabs: 1, 2, 4, 8 mg.
Adverse effects:
1) orthostatic hypotension
2) reflex tachycardia
3) precipitation of heart failure? [3]*
4) development of tolerance
5) dizziness
6) nasal congestion
7) stress urinary incontinence, especially in women with pelvic organ prolapse [6]
* in the ALLHAT study, the doxazosin arm was discontinued early due to a high incidence of heart failure [3]
Mechanism of action:
1) alpha-1 adrenergic receptor antagonist
2) reduces total peripheral resistance through both arterial & venous dilation
3) increases urine flow in BPH by relaxing smooth muscle tone in the bladder neck of the prostate
5) relaxes internal urethral sphincter*
7) enhances glycolysis [5]
- may improve glucose tolerance with long-term therapy
8) may lower risk of Parkinson's disease (RR=0.88) [5]
* may increase risk of stress urinary incontinence [6]
Interactions
drug interactions
drug adverse effects (more general classes)
General
alpha-1 adrenergic receptor antagonist; prostate-selective alpha blocker
piperazinyl quinazoline
Properties
MISC-INFO: elimination route LIVER
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Prescriber's Letter 8(7):38 2001
- Journal Watch 23(3):21, 2003
Major outcomes in high-risk hypertensive patients randomized
to angiotensin-converting enzyme inhibitor or calcium channel
blocker vs diuretic: The Antihypertensive and Lipid-Lowering
Treatment to Prevent Heart Attack Trial (ALLHAT).
JAMA. 2002 Dec 18;288(23):2981-97.
PMID: 12479763
- The Antihypertensive and Lipid-Lowering Treatment to
Prevent Heart Attack Trial (ALLHAT)
http://www.nhlbi.nih.gov/health/allhat/index.htm
- Deprecated Reference
- Simmering JE, Welsh MJ, Liu L et al
Association of Glycolysis-Enhancing alpha-1 Blockers With Risk
of Developing Parkinson Disease.
JAMA Neurol. 2021;78(4):407-413. Feb 1.
PMID: 33523098 PMCID: PMC7851758 Free PMC article
https://jamanetwork.com/journals/jamaneurology/fullarticle/2775976
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Department of Veterans Affairs, VA National Formulary