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Doxazosin

A Review of its Pharmacodynamic and Pharmacokinetic Properties, and Therapeutic Efficacy in Mild or Moderate Hypertension

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Summary

Synopsis

Doxazosin is a long-acting selective α1-adrenoceptor antagonist structurally related to prazosin. Like prazosin, doxazosin exerts its antihypertensive effect by reducing total peripheral resistance by selective postsynaptic α1-blockade, without reducing cardiac output, and similarly, doxazosin appears to have a negligible effect on heart rate. Doxazosin differs from prazosin in that its long half-life enables once-a-day oral administration. Doxazosin significantly lowers both standing and supine blood pressure and appears to maintain this antihypertensive effect over a 24-hour dosing interval. Doxazosin 1 to 16mg once daily has been found to be comparable in efficacy to atenolol 50 to 100mg and prazosin 1 to 20mg daily. Characteristic of α1-adrenoceptor antagonists, doxazosin also has favourable effects on the plasma lipid profile in that it decreases total cholesterol and triglycerides, and increases high density lipoprotein (HDL) cholesterol as well as the HDL/total cholesterol ratio. Although further long term trials are needed to clarify the role of doxazosin in multidrug regimens in more severe hypertension, it appears to be a suitable drug for consideration as first-line therapy in mild to moderate essential hypertension.

Pharmacodynamic Studies

Doxazosin reduces blood pressure by reducing peripheral resistance through selective α1-adrenoceptor inhibition, without reducing cardiac output. The specific selectivity of doxazosin for α1-adrenoceptors and its lack of effect at pre-junctional α2-adrenoceptors has also been demonstrated in anaesthetised cats and dogs, and in isolated rabbit pulmonary artery preparations and ligand binding studies in rat brain membranes. Doxazosin reduces blood pressure in dogs with experimentally induced renal hypertension. Doxazosin has been shown to significantly reduce mean arterial blood pressure at rest in both supine and sitting positions, and following bicycle ergometric exercise, with significant reduction in total peripheral resistance, whether administered in a single intravenous bolus (0.5 to 1mg) or following long term administration for up to 1 year (2 to 16mg single oral daily dose). During doxazosin administration there was a consistent, trend towards a decrease in plasma total cholesterol and triglycerides and an increase in high density lipoprotein (HDL) cholesterol as well as HDL/total cholesterol ratio. Doxazosin appears to increase both renal blood flow and active renin. A significant 10.7% increase in renal blood flow without an effect on blood pressure has been demonstrated in hypertensive patients following intrarenal artery infusion of doxazosin (1µg/kg/min), whereas at lower doses (0.1 to 0.3 µg/kg/min) these effects were not observed.

Oral doxazosin (1 to 12 mg/day) consistently reduced both standing systolic and diastolic blood pressure, with smaller reductions in supine systolic and diastolic pressures. Like prazosin, doxazosin produced virtually no change in heart rate.

Pharmacokinetic Studies

Dose related mean peak plasma concentrations have been observed following single dose oral administration of doxazosin 1 to 16mg to hypertensive patients, and mean peak plasma concentrations following single 1mg oral doses of doxazosin in patients with kidney failure were similar to those observed in other hypertensive patients included in therapeutic studies. For single oral doses, bioavailability has been calculated to be between 62 and 69%. Mean apparent volume of distribution following a 1 mg intravenous bolus dose of doxazosin appears to be about 0.97 L/kg in healthy young subjects (mean age 29 years) and is increased to around 1.69 L/kg in healthy elderly subjects (mean age 71 years).

The pathway for doxazosin metabolism appears to be demethylation and hydroxylation, with the major route of elimination being faecal (63 to 65%); 5 to 9% is excreted in the urine. In studies which used a sampling time of up to 32 hours, elimination half-life of doxazosin was approximately 9 to 12 hours in hypertensive or normal healthy subjects following single dose oral or intravenous doses. When sampling time was extended to 54 and 96 hours, half-life was calculated as 17 to 20 and 22 hours, respectively, at steady-state.

Total plasma clearance of doxazosin is about 4.98 L/h (83 ml/min) in young (mean age 29 years) normotensive subjects. A clearance of 8.34 and 8.39 L/h has been reported following a single 2mg oral dose in young and elderly normotensive subjects, respectively.

Therapeutic Trials

Doxazosin has been used in the treatment of mild to moderate hypertension in both young and elderly patients. A number of medium to long term studies demonstrate that oral treatment with doxazosin significantly reduces both standing and supine blood pressures.

Double-blind parallel group comparative studies have shown that doxazosin 1 to 16mg once daily in individually titrated doses is generally similar in antihypertensive efficacy to prazosin 1 to 20mg daily (given twice daily) and atenolol 50 to 100mg once daily. Initial studies suggest that doxazosin is at least as effective as nadolol 40 to 160mg and of similar efficacy to metoprolol 100 to 200mg daily, but further studies in larger patient groups are needed to fully determine their relative efficacy. Similarly, the relative efficacy of doxazosin 1 to 16mg once daily and hydrochlorothiazide 25 to 100mg once daily remains to be clarified. Preliminary data suggest that doxazosin is of similar efficacy in elderly and younger patients, as well as in Blacks and Caucasians.

Side Effects

The side effects that have been reported in patients receiving medium to long term therapy were mild to moderate in severity. Most frequently reported side effects were headache, vertigo, dizziness, postural dizziness, lethargy and oedema, which occurred in 6.8 to 15.8% of patients and appear to be similar to those seen with therapeutically equivalent doses of other antihypertensive agents. The incidence and profile of reported side effects appear to be no more pronounced in elderly patients than for the total population.

Dosage and Administration

Doxazosin has been used in individually titrated doses ranging from 1 to 16mg per day given as a single daily oral dose. Mean maintenance doses are expected to be 2 to 4mg administered as a single daily oral dose.

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Authors and Affiliations

  1. University of Arkansas for Medical Sciences, Little Rock, USA

    Ronald A. Young & Rex N. Brogden

  2. ADIS Drug Information Services, 41 Centorian Drive, Private Bag, Mairangi Bay, Auckland 10, New Zealand

    Ronald A. Young & Rex N. Brogden

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  1. Ronald A. Young
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Various sections of the manuscript reviewed by: P.A. Abraham, The Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis, Minnesota, USA; R.R. Bailey, Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand; H.L. Elliot, University Department of Materia Medica, Stobhill General Hospital, Glasgow, Scotland; Y. Goto, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, Japan; K. Hayduk, Marien Hospital, Dusseldorf, Rochusstrasse, Federal Republic of Germany; A. Lehtonen, Department of Medicine, Turku City Hospital, Turku, Finland; N.T. Nash, Syracuse, New York, USA; H. Shionoiri, Department of Internal Medicine, Yokohama City University, Yokohama, Japan; G. Stokes, Department of Clinical Pharmacology, Royal North Shore Hospital, New South Wales, Australia; J. McMurray, Department of Pharmacology and Clinical Pharmacology, University of Dundee, Dundee, Scotland; P.A. Meredith, University Department of Materia Medica, Stobhill General Hospital, Glasgow, Scotland; B.N. Trost, Medizinische Poliklinik, Inselspital-Bern, Bern, Switzerland; D.T. Torvik, Medical Department, Rikshospitalet, Oslo, Norway.

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Young, R.A., Brogden, R.N. Doxazosin. Drugs 35, 525–541 (1988). https://doi.org/10.2165/00003495-198835050-00003

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