GD is an 82-year-old patient is taking 2 mg of terazosin for BPH who comes in complaining of dizziness, generalized muscle weakness and persistent LUTS. He also inquires if the terazosin will prevent "his prostate from getting any bigger and the disease from progressing". How should you advise these patients and manage their medications? What was the process you went through to assess her current medications and to recommend an updated regimen?

Patient 2 The patient is likely experiencing side effects of terazosin which has the potential to cause hypotension, malaise, and muscle pain. The recommended timing of administration for terazosin is at night because of these side effects. The patient is also on the lowest initial dose at 2mg so one can assume the plan had been to titrate the dosage until there was relief of lower urinary tracts symptoms (LUTS). Generally, as long as the patient can tolerate the side effects when taken at the recommended time, terazosin is not discontinued. A full medication history should be reviewed with this patient as antihypertensives, diuretics, antihistamines, and decongestants can exacerbate hypotension or voiding symptoms. The medication plan with this patient should be to take the terazosin at bedtime and then follow-up with the patient in 2-4 weeks for evaluation of up titration of dosing. If the patient returns and continues to have persistent LUTS, it would be appropriate to evaluate the patient for combination therapy of terazosin with a 5-alpha reductase inhibitor (5-ARI). 5-ARIs are effective in reducing prostate volume and slowing the disease progression. Kim and Andriole (2018) noted study results showing risks of acute urinary retention, renal insufficiency, urinary tract infections was reduced by 66% in combination therapy versus 39% in monotherapy

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