Doxazosin

Doxazosin
Names
Trade namesCardura, Carduran, others
IUPAC name
  • (RS)-2-[4-(2,3-Dihydro-1,4-benzodioxine-2-carbonyl)piperazin-1-yl]-6,7-dimethoxyquinazolin-4-amine
Clinical data
Drug classα1-selective adrenergic blocker[1]
Main usesEnlarged prostate, high blood pressure[1]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Routes of
use		By mouth (tablets)
Defined daily dose4 mg[2]
External links
AHFS/Drugs.comMonograph
MedlinePlusa693045
Legal
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetics
Bioavailability65%
Protein binding98%
MetabolismLiver
Elimination half-life22 hours
Chemical and physical data
FormulaC23H25N5O5
Molar mass451.483 g·mol−1
3D model (JSmol)
ChiralityRacemic mixture
SMILES
  • O=C(N3CCN(c2nc1cc(OC)c(OC)cc1c(n2)N)CC3)C4Oc5c(OC4)cccc5
InChI
  • InChI=1S/C23H25N5O5/c1-30-18-11-14-15(12-19(18)31-2)25-23(26-21(14)24)28-9-7-27(8-10-28)22(29)20-13-32-16-5-3-4-6-17(16)33-20/h3-6,11-12,20H,7-10,13H2,1-2H3,(H2,24,25,26) checkY
  • Key:RUZYUOTYCVRMRZ-UHFFFAOYSA-N checkY

Doxazosin, sold under the brand names Cardura among others, is a medication used to treat symptoms of an enlarged prostate and high blood pressure.[1] For high blood pressure, it is a less preferred option.[1] It is taken by mouth.[1]

Common side effects include dizziness, sleepiness, swelling, nausea, shortness of breath, and abdominal pain.[1] Severe side effects may include low blood pressure with standing, an irregular heart beat, and priapism.[1][3] Prostate cancer should be ruled out before starting treatment.[1] It is a α1-selective adrenergic blocker in the quinazoline class of compounds.[1]

Doxazosin was patented in 1977 and came into medical use in 1988.[4] It is available as a generic medication.[3] A month supply in the United Kingdom costs the NHS about £0.50 as of 2019.[3] In the United States the wholesale cost of this amount is about US$5.50.[5] The modified-release form is more expensive without any particular advantage over the standard form.[6] In 2017, it was the 150th most commonly prescribed medication in the United States, with more than four million prescriptions.[7][8]

Medical uses

Doxazosin is available as a standard form and a modified-release (branded) form.[6] It is generally a second-line option for treating high blood pressure combined with other antihypertensives.[6] In a man with high blood pressure and a large non-cancerous prostate, it may prove more useful to start doxazosin earlier.[6] It is usually taken at night.[6] If a person taking doxazosin needs to get up at night, they should so slowly.[6]

High blood pressure

Doxazosin is usually added to other antihypertensive therapy such as calcium channel antagonists, diuretics, beta-adrenoreceptor antagonists, angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers.[9]

Like other alpha-1 receptor antagonists, it has a role in the peri-operative management of pheochromocytoma.[10]

Benign prostatic hypertrophy

Doxazosin is considered to be effective in reducing urinary symptom scores and improving peak urinary flow in men with benign prostatic hypertrophy.[11]

Dosage

The defined daily dose is 4 mg by mouth.[2]

Side effects

Doxazosin is generally considered to be safe, well tolerated and effective as an add-on antihypertensive medication.[12]

History

In March 2000, the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study stopped its arm of the trial looking at alpha blockers, because doxazosin was less effective than a simple diuretic, and because patients on doxazosin had a 25% higher rate of cardiovascular disease and twice the rate of congestive heart failure as patients on diuretics.[13] Pfizer, aware of the results before publication, launched a marketing campaign in early 2000, and sales were largely unaffected, despite the dangers highlighted by the study.[14][15]

Society and culture

Cost

A month supply in the United Kingdom costs the NHS about £0.50 as of 2019.[3] In the United States the wholesale cost of this amount is about US$5.50.[5] In 2017, it was the 150th most commonly prescribed medication in the United States, with more than four million prescriptions.[7][8]

  • Doxazosin costs (US)
    Doxazosin costs (US)
  • Doxazosin prescriptions (US)
    Doxazosin prescriptions (US)

References

  1. 1 2 3 4 5 6 7 8 9 "Doxazosin Mesylate Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Archived from the original on 5 October 2020. Retrieved 17 March 2019.
  2. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 26 October 2020. Retrieved 7 September 2020.
  3. 1 2 3 4 British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 765. ISBN 9780857113382.
  4. ↑ Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 455. ISBN 9783527607495. Archived from the original on 2019-12-22. Retrieved 2019-02-28.
  5. 1 2 "NADAC as of 2019-02-27". Centers for Medicare and Medicaid Services. Archived from the original on 2019-03-06. Retrieved 3 March 2019.
  6. 1 2 3 4 5 6 Hitchings, Andrew; Lonsdale, Dagan; Burrage, Daniel; Baker, Emma (2019). The Top 100 Drugs: Clinical Pharmacology and Practical Prescribing (2nd ed.). Elsevier. pp. 26–27. ISBN 978-0-7020-7442-4. Archived from the original on 2021-05-22. Retrieved 2021-11-09.
  7. 1 2 "The Top 300 of 2020". ClinCalc. Archived from the original on 12 February 2021. Retrieved 11 April 2020.
  8. 1 2 "Doxazosin Mesylate - Drug Usage Statistics". ClinCalc. Archived from the original on 5 October 2020. Retrieved 11 April 2020.
  9. ↑ Wykretowicz A, Guzik P, Wysocki H (March 2008). "Doxazosin in the current treatment of hypertension". Expert Opinion on Pharmacotherapy. 9 (4): 625–33. doi:10.1517/14656566.9.4.625. PMID 18312163.
  10. ↑ Mazza A, Armigliato M, Marzola MC, Schiavon L, Montemurro D, Vescovo G, Zuin M, Chondrogiannis S, Ravenni R, Opocher G, Colletti PM, Rubello D (April 2014). "Anti-hypertensive treatment in pheochromocytoma and paraganglioma: current management and therapeutic features". Endocrine. 45 (3): 469–78. doi:10.1007/s12020-013-0007-y. PMID 23817839.
  11. ↑ Yuan J, Liu Y, Yang Z, Qin X, Yang K, Mao C (March 2013). "The efficacy and safety of alpha-1 blockers for benign prostatic hyperplasia: an overview of 15 systematic reviews". Current Medical Research and Opinion. 29 (3): 279–87. doi:10.1185/03007995.2013.766594. PMID 23323875.
  12. ↑ Chapman N, Chen CY, Fujita T, Hobbs FD, Kim SJ, Staessen JA, Tanomsup S, Wang JG, Williams B (September 2010). "Time to re-appraise the role of alpha-1 adrenoceptor antagonists in the management of hypertension?". Journal of Hypertension. 28 (9): 1796–803. doi:10.1097/HJH.0b013e32833b912c. PMID 20543713.
  13. ↑ Piller LB, Davis BR, Cutler JA, Cushman WC, Wright JT, Williamson JD, Leenen FH, Einhorn PT, Randall OS, Golden JS, Haywood LJ (November 2002). "Validation of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants Assigned to Doxazosin and Chlorthalidone". Current Controlled Trials in Cardiovascular Medicine. 3 (1): 10. doi:10.1186/1468-6708-3-10. PMC 149403. PMID 12459039.
  14. ↑ Goldacre, Ben (2012) Bad Pharma How drug companies mislead doctors and harm patients, Fourth Estate, ISBN 0007350740.
  15. ↑ Lenzer J (2003-01-18). "Spin doctors soft pedal data on antihypertensives". BMJ. 326 (7381): 170. doi:10.1136/bmj.326.7381.170. PMC 1128917.
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