Compare Hytrin (Terazosin) with Alternatives for BPH and High Blood Pressure

If you’ve been prescribed Hytrin (terazosin) for high blood pressure or an enlarged prostate, you’re not alone. But you might be wondering: are there better, cheaper, or safer options out there? The truth is, terazosin isn’t the only alpha-blocker on the shelf - and it’s not always the first choice anymore. With newer drugs, lower side effect profiles, and evolving guidelines, it’s worth knowing what else works - and what might work better for you.

What is Hytrin (Terazosin) actually used for?

Terazosin, sold under the brand name Hytrin, is an alpha-1 blocker. It relaxes muscles in the prostate and bladder neck, making it easier to urinate. It also widens blood vessels, lowering blood pressure. That’s why it’s been used for two main conditions: benign prostatic hyperplasia (BPH) and hypertension.

But here’s the catch: while it works, it’s not the go-to anymore. The 2023 American Urological Association guidelines now list tamsulosin and silodosin as preferred first-line treatments for BPH because they’re more targeted and cause fewer drops in blood pressure. For high blood pressure, guidelines from the British Hypertension Society and NICE recommend ACE inhibitors, calcium channel blockers, or thiazide diuretics before alpha-blockers like terazosin.

So why is terazosin still around? Because it’s cheap, it’s been around for decades, and for some people, it still does the job - especially if they have both BPH and high blood pressure. But if you’re starting treatment, or if terazosin isn’t working well for you, there are better options.

Top alternatives to Hytrin for BPH

When it comes to treating an enlarged prostate, the goal is to improve urine flow and reduce symptoms like frequent urination, weak stream, or nighttime trips to the bathroom. Here are the main alternatives:

• Tamsulosin (Flomax): This is the most common alternative. Unlike terazosin, it’s selective for alpha-1A receptors in the prostate, meaning it doesn’t affect blood vessels as much. That means less dizziness or fainting when standing up. Most men start with tamsulosin because it’s effective and has fewer systemic side effects.
• Silodosin (Rapaflo): Even more prostate-specific than tamsulosin. It’s great for men with severe urinary symptoms but can cause retrograde ejaculation (semen going backward into the bladder during orgasm). That’s not harmful, but it can be a dealbreaker for some.
• Doxazosin (Cardura): This is another non-selective alpha-blocker like terazosin. It’s similar in how it works, side effects, and cost. Many doctors switch patients from terazosin to doxazosin simply because it’s available as a once-daily extended-release tablet, which improves adherence.
• Alfuzosin (Uroxatral): Also non-selective, but marketed as having a lower risk of orthostatic hypotension (sudden blood pressure drop). It’s taken once daily and doesn’t require dose titration like terazosin.

One big advantage of tamsulosin and silodosin? You don’t need to start low and go slow. With terazosin, you often begin at 1 mg and slowly increase over weeks to avoid fainting. With tamsulosin, you start at 0.4 mg and stay there. Fewer trips to the ER because you stood up too fast.

Alternatives for high blood pressure

If your main reason for taking terazosin is high blood pressure, you’re likely taking it because other drugs didn’t work - or because you have both BPH and hypertension. But alpha-blockers are now considered third-line for hypertension alone.

Here’s what doctors recommend instead:

• ACE inhibitors (e.g., lisinopril): These are first-choice for people under 55, especially if they have diabetes or kidney disease. They protect the kidneys and reduce protein in the urine.
• Calcium channel blockers (e.g., amlodipine): First-line for people over 55, or of African or Caribbean descent. They’re effective, well-tolerated, and don’t cause dizziness.
• Thiazide diuretics (e.g., chlorthalidone): Cheap, proven to reduce heart attacks and strokes over the long term. Often combined with other drugs.
• ARBs (e.g., losartan): Similar to ACE inhibitors but without the dry cough side effect. Good alternative if you can’t tolerate lisinopril.

Terazosin can still be added if blood pressure remains high, but it’s rarely the starter drug. A 2024 meta-analysis in The Lancet found that alpha-blockers like terazosin were less effective at preventing heart attacks and strokes compared to calcium channel blockers or ACE inhibitors.

Side effects comparison: Hytrin vs. alternatives

Not all alpha-blockers are created equal when it comes to side effects. Here’s how they stack up:

The "first-dose effect" - sudden, severe dizziness or fainting after the first pill - is a real risk with terazosin and doxazosin. That’s why doctors tell you to take the first dose at bedtime. Tamsulosin and silodosin don’t have this issue, which makes them much safer for older adults or those living alone.

Cost and accessibility

Terazosin is one of the cheapest alpha-blockers available. In the UK, a 30-day supply of generic terazosin 5 mg costs around £4. Tamsulosin is slightly more expensive - about £8-£12 for 30 capsules. Silodosin is pricier still, often £15-£20.

But here’s the thing: if terazosin causes dizziness and you end up falling, or need to go to the hospital, or miss work because you’re too dizzy to drive - the real cost skyrockets. Many GPs now prescribe tamsulosin as first-line even if it’s a bit more expensive upfront, because it reduces long-term risks.

Insurance and NHS prescriptions in the UK cover all of these, so out-of-pocket cost isn’t always the deciding factor. What matters is which drug keeps you safe, symptom-free, and out of the emergency room.

When should you stick with Hytrin?

It’s not all bad news for terazosin. There are still good reasons to use it:

• You’re already on it and doing fine - no dizziness, good urine flow, stable BP.
• You have both BPH and high blood pressure, and terazosin is controlling both without needing extra meds.
• You can’t afford tamsulosin or silodosin and have no history of fainting or falls.
• Your doctor has tried other drugs and they didn’t work.

If you’re stable on terazosin, there’s no need to switch. But if you’re experiencing side effects, or if your symptoms aren’t improving, it’s time to talk about alternatives.

What about non-drug options?

Medication isn’t the only path. For mild to moderate BPH, lifestyle changes can make a big difference:

• Limit fluids before bedtime to reduce nighttime urination.
• Avoid caffeine and alcohol - they irritate the bladder.
• Double voiding: urinate, wait 30 seconds, then try again to empty the bladder fully.
• Regular exercise - studies show men who walk 30 minutes a day have fewer BPH symptoms.

For men who don’t respond to drugs, minimally invasive procedures like UroLift or Rezum are now common. These don’t require general anesthesia, have quick recovery times, and preserve sexual function. They’re not for everyone, but they’re worth discussing if medications aren’t working.

What’s the bottom line?

Hytrin (terazosin) isn’t obsolete - but it’s no longer the best starting point for most people. If you’re new to treatment, tamsulosin is the safer, more convenient choice for BPH. For high blood pressure, ACE inhibitors, calcium channel blockers, or diuretics are more effective at preventing long-term complications.

Switching from terazosin isn’t always necessary, but it’s often better. Talk to your doctor if you’re having dizziness, fainting spells, or if your symptoms aren’t improving. You deserve a treatment that works without putting you at risk.

And remember: what works for one person doesn’t work for another. Your body, your symptoms, your lifestyle - those matter more than any brand name or price tag.