Doxazosin Use in Medical Practice

Indications and Mechanism

The American Urological Association (AUA) recommends doxazosin as an appropriate option for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), with equivalent clinical efficacy to other alpha-1 blockers 1, 2, 3, 4, 5, 6
Doxazosin acts by blocking alpha-1 adrenergic receptors, resulting in relaxation of the smooth muscle of the prostate and bladder neck to treat LUTS symptoms 1, 2, 3
Doxazosin reduces blood pressure through peripheral vasodilation in hypertensive patients 1, 2, 7, 8

The use of doxazosin is associated with a risk of weight gain, likely due to expansion of extracellular fluid volume, as seen in the ALLHAT study 9
Doxazosin may cause asthenia (weakness), which can contribute to weight gain by altering energy balance 9
Doxazosin can cause orthostatic hypotension, a primary adverse effect that can be potentiated by antidepressants and antipsychotics 1, 2, 3, 7, 8
Common adverse events include orthostatic hypotension 3, dizziness 9, fatigue/asthenia 9, ejaculatory problems 1, and nasal congestion 4

Doxazosin monotherapy was associated with a higher incidence of congestive heart failure compared to other antihypertensives in men with hypertension and cardiac risk factors in the ALLHAT study 1, 2, 3, 4, 6

The American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend considering alpha-1 blockers like doxazosin as second-line agents for hypertensive patients, particularly those with concomitant BPH 7, 8
For psychiatric patients with hypertension, doxazosin may be considered for its approved indications, but careful monitoring of interactions with psychotropic medications is necessary, especially for the increased risk of orthostatic hypotension and sedation 7, 8