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

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 options? Safer ones? Cheaper ones? This isn’t about switching meds on a whim-it’s about understanding what else is out there and whether another drug might work better for your body, your lifestyle, or your budget.

What Hytrin (Terazosin) Actually Does

Hytrin is the brand name for terazosin, an alpha-1 blocker. It works by relaxing the muscles in your blood vessels and the prostate. That means two things: lower blood pressure and easier urine flow. It’s been around since the 1980s, and while newer drugs exist, it’s still used because it’s effective, especially for men with both high blood pressure and benign prostatic hyperplasia (BPH).

But terazosin has a reputation for causing dizziness-especially when you first start taking it or if you increase the dose. That’s because it drops your blood pressure quickly, and your body needs time to adjust. Many people report feeling lightheaded when standing up, which increases fall risk, especially in older adults.

It’s not a first-line choice anymore for high blood pressure alone. Guidelines from the American College of Cardiology and the British Hypertension Society now recommend calcium channel blockers or thiazide diuretics before alpha blockers like terazosin. But for BPH, it’s still a solid option-if you can handle the side effects.

Alternative 1: Tamsulosin (Flomax)

Tamsulosin is the most common alternative to terazosin for BPH. Unlike terazosin, it’s highly selective for receptors in the prostate and bladder neck. That means it helps with urine flow without dropping blood pressure as much.

Studies show tamsulosin improves urinary symptoms just as well as terazosin-but with far fewer cases of dizziness or fainting. A 2021 meta-analysis in the Journal of Urology found that patients on tamsulosin were 60% less likely to experience orthostatic hypotension than those on terazosin.

That makes tamsulosin the go-to for men over 65, or anyone with a history of falls or low blood pressure. It’s also taken once a day, usually 30 minutes after the same meal each day, which helps with consistency.

Downside? Tamsulosin doesn’t help with high blood pressure. If you need to treat both conditions, you’ll still need a separate blood pressure pill. But for pure BPH, it’s the safer, smarter pick.

Alternative 2: Doxazosin (Cardura)

Doxazosin is almost identical to terazosin-same class, same mechanism, same side effects. The main difference? Half-life. Doxazosin lasts longer in your system, so it’s taken once daily, while terazosin can sometimes require two doses.

But here’s the catch: doxazosin has the same dizziness risk as terazosin. In fact, the ALLHAT trial (a major NIH study from 2002) found that men on doxazosin had a higher risk of heart failure compared to those on chlorthalidone (a diuretic). That’s why doxazosin is rarely used for high blood pressure anymore.

For BPH, it’s still an option, but unless your insurance forces you to try it first, there’s little reason to choose doxazosin over tamsulosin. The side effect profile is nearly identical to terazosin, with no clear advantage.

Alternative 3: Alfuzosin (Uroxatral)

Alfuzosin is another alpha blocker, but it’s formulated as an extended-release tablet. That means it releases slowly, which helps reduce the sudden drop in blood pressure that causes dizziness.

Like tamsulosin, it’s prostate-selective. Clinical trials show it improves urinary flow and reduces nighttime urination without significantly lowering blood pressure. It’s also taken once daily, usually after the same meal.

One study in the European Urology journal found alfuzosin had a 45% lower rate of dizziness than terazosin over 12 weeks. It’s a good middle ground-effective for BPH, fewer side effects than terazosin, and no blood pressure impact.

It’s not as widely prescribed as tamsulosin, but if you’re in the UK and your GP prefers alternatives, alfuzosin is often on the NHS formulary.

Alternative 4: 5-alpha reductase inhibitors (Finasteride, Dutasteride)

These aren’t alpha blockers-they work differently. Finasteride (Proscar) and dutasteride (Avodart) shrink the prostate over time by blocking the hormone that causes it to grow. They don’t relax muscles like terazosin does.

That means they’re slower. You won’t feel better for 3-6 months. But if your prostate is really enlarged (over 40 grams), these drugs can reduce the risk of needing surgery later.

They’re often combined with tamsulosin for men with moderate-to-severe BPH. That combo-called combination therapy-is one of the most effective long-term strategies. It’s not a quick fix, but it’s a game-changer for men who want to avoid surgery.

Downsides? Sexual side effects: lower libido, erectile dysfunction, and reduced semen volume. These are reversible but can be frustrating. Also, dutasteride can raise your risk of high-grade prostate cancer slightly, according to the REDUCE trial.

Alternative 5: Combination Drugs (e.g., Jalyn)

Jalyn is a single pill that combines dutasteride and tamsulosin. It’s convenient-you take one pill instead of two. It’s also more effective than either drug alone for men with larger prostates.

But it’s expensive. In the UK, it’s not routinely available on the NHS unless you’ve tried other options first. If you’re paying out of pocket, it can cost over £100 a month.

It’s a good choice if you’re committed to long-term BPH control and can afford it. But for most people, taking tamsulosin and finasteride separately is just as effective and cheaper.

Alternative 6: Non-Alpha Blocker Options for BPH

Not everyone needs a drug that affects blood pressure. If your main issue is urinary symptoms, there are other paths:

• PDE5 inhibitors like tadalafil (Cialis): Approved for BPH at 5mg daily. Improves both urinary flow and erectile function. Good for men with both issues.
• Mirabegron (Myrbetriq): Works on bladder muscle, not prostate. Helps with urgency and frequency. Often used for overactive bladder, but can help some BPH symptoms.
• Phytotherapy: Saw palmetto extract. Evidence is mixed, but some men report mild improvement. Not regulated like prescription drugs, so quality varies.

These aren’t replacements for alpha blockers in severe cases, but they’re useful for mild symptoms or when you want to avoid sexual side effects.

When to Stick With Terazosin

You might still be on terazosin for good reasons:

• You’re already stable on it-with no dizziness or falls.
• You have both high blood pressure and BPH, and it’s working well for both.
• Your insurance covers it, and alternatives are too expensive.
• You’ve tried other drugs and had bad reactions.

If you’re doing fine, there’s no need to switch. But if you’re experiencing dizziness, fatigue, or low energy, it’s worth asking your doctor about alternatives.

Cost Comparison (UK, 2025)

Prices vary by pharmacy and prescription type, but here’s a rough idea of monthly costs for a 30-day supply:

NHS prescriptions in England cost £9.65 per item, regardless of drug. In Scotland, Wales, and Northern Ireland, prescriptions are free. Private prices are for pharmacy purchases without a prescription.

What Your Doctor Will Ask Before Switching

If you ask about alternatives, your doctor won’t just hand you a new script. They’ll want to know:

• Are you having dizziness, fainting, or falls?
• Is your urine flow improving? Are you still waking up 3+ times a night?
• Do you have heart problems or low blood pressure?
• Are you taking other meds that lower BP (like nitrates or PDE5 inhibitors)?
• What’s your budget? Are you paying out of pocket?

They might also check your prostate-specific antigen (PSA) level or refer you for a bladder scan. BPH isn’t just about symptoms-it’s about ruling out prostate cancer.

Final Advice: Don’t Switch Without a Plan

Switching from terazosin to another drug isn’t as simple as swapping pills. Stopping terazosin suddenly can cause your blood pressure to spike. Starting a new alpha blocker requires a low dose and slow uptitration.

Always work with your doctor. If you’re tired of dizziness, ask about tamsulosin or alfuzosin. If your prostate is growing, ask about finasteride. If you’re paying too much, ask about generics.

There’s no single best drug. The best one is the one that works for you-without making you feel worse.