Minipress (prazosin hydrochloride)
Alpha1 blocker (quinazoline)
Treatment of HTN either alone or in combination w/ other antihypertensive drugs (eg, diuretics, β-blockers).
Initial: 1mg bid-tid
Titrate: May slowly increase to a total of 20mg/day in divided doses
Maint: 6-15mg/day in divided doses
Doses >20mg usually do not increase efficacy; however, some may benefit from further increases up to 40mg/day in divided doses
May maintain adequately on a bid dose regimen
Use w/ a Diuretic or Other Antihypertensive Agent:
Reduce to 1mg or 2mg tid, then retitrate
Use w/ a PDE-5 Inhibitor:
Initiate PDE-5 inhibitor at the lowest dose
Cap: 1mg, 2mg, 5mg
May cause syncope w/ sudden loss of consciousness; minimize syncopal episodes by limiting initial dose to 1mg, by subsequently increasing the dose slowly, and by introducing any additional antihypertensive w/ caution. Prolonged erections and priapism reported; penile tissue damage and permanent loss of potency may result if priapism is not treated immediately. Intraoperative floppy iris syndrome observed during cataract surgery. False (+) results may occur in screening tests for pheochromocytoma; d/c w/ elevated urinary vanillylmandelic acid levels and retest after 1 month.
Dizziness, headache, drowsiness, lack of energy, weakness, palpitations, N/V, edema, orthostatic hypotension, dyspnea, syncope, depression, urinary frequency, diarrhea.
See Dose Modification. Additive hypotensive effects w/ diuretics, β-blockers (eg, propranolol), or other antihypertensives. Additive BP-lowering effects and symptomatic hypotension w/ PDE-5 inhibitors.
PREGNANCY AND LACTATION
Category C, caution in nursing.
MECHANISM OF ACTION
α1-blocker (quinazoline derivative); has not been established. Causes a decrease in total peripheral resistance and thought to have a direct relaxant action on vascular smooth muscle.
Absorption: Tmax=3 hrs. Distribution: Plasma protein binding (highly bound); found in breast milk. Metabolism: Extensive. Primarily by demethylation and conjugation. Elimination: Bile and feces; T1/2=2-3 hrs.
Assess for previous hypersensitivity to drug/quinazolines, pregnancy/nursing status, and for possible drug interactions. Obtain baseline BP.
Monitor for signs/symptoms of hypotension, dizziness, lightheadedness, syncope, priapism, and other adverse reactions.
Inform that dizziness or drowsiness may occur after 1st dose; instruct to avoid driving or performing hazardous tasks for first 24 hrs after taking the drug or when dose is increased. Advise that dizziness, lightheadedness, or fainting may occur, especially when rising from a lying or sitting position; inform that getting up slowly may lessen these problems. Inform that these problems may also occur if taking alcohol, standing for long periods, exercising, or during hot weather, and advise caution during these situations. Instruct to seek immediate medical attention if an erection persists >4 hrs.
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