Alpha-blockers, also known as α-blockers or α-adrenoreceptor antagonists, are a class of pharmacological agents that act as antagonists on α-adrenergic receptors (α-adrenoceptors).
Historically, alpha-blockers were used as a tool for pharmacologic research to develop a greater understanding of the autonomic nervous system. Using alpha blockers, scientists began characterizing arterial blood pressure and central vasomotor control in the autonomic nervous system. Today, they can be used as clinical treatments for a limited number of diseases.
Alpha blockers can treat a small range of diseases such as hypertension, Raynaud's disease, benign prostatic hyperplasia (BPH) and erectile dysfunction. Generally speaking, these treatments function by binding an α-blocker to α receptors in the arteries and smooth muscle. Ultimately, depending on the type of alpha receptor, this relaxes the smooth muscle or blood vessels, which increases fluid flow in these entities.
Classification
α1-blockers act on α1-adrenoceptors
α2-blockers act on α2-adrenoceptors
When the term "alpha blocker" is used without further qualification, it can refer to an α1 blocker, an α2 blocker, a nonselective blocker (both α1 and α2 activity), or an α blocker with some β activity. However, the most common type of alpha blocker is usually an α1 blocker.
Non-selective α-adrenergic receptor antagonists include: Phenoxybenzamine Phentolamine Tolazoline Trazodone
Selective α1-adrenergic receptor antagonists include: Alfuzosin Doxazosin Prazosin (inverse agonist) Tamsulosin Terazosin Silodosin
Selective α2-adrenergic receptor antagonists include: Atipamezole Idazoxan Mirtazapine Yohimbine
Finally, the agents carvedilol and labetalol are both α and β-blockers.
Below are some of the most common drugs used in the clinic.
Medical uses
While there are limited clinical α-blocker uses, in which most α-blockers are used for hypertension or benign prostatic hyperplasia , α-blockers can be used to treat a few other diseases, such as Raynaud's disease, congestive heart failure (CHF), pheochromocytoma, and erectile dysfunction.
Furthermore, α-blockers can occasionally be used to treat anxiety and panic disorders, such as posttraumatic stress disorder (PTSD) induced nightmares. Studies have also had great medical interest in testing alpha blockers, specifically α2 blockers, to treat type II diabetes and psychiatric depression.
Hypertension
Hypertension is due to an increase in vascular resistance and vasoconstriction. Using α1 selective antagonists, such as prazosin, has been efficacious in treating mild to moderate hypertension. This is because they can decrease vascular resistance and decrease pressure. However, while these drugs are generally well tolerated, they have the potential to produce side effects such as orthostatic hypotension and dizziness. However, unlike other treatments for hypertension such as ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics or beta blockers, alpha blockers have not demonstrated the same mortality and morbidity benefits, and are therefore not generally used as first or even second line agents.
Another treatment for hypertension is using drugs that have both α1 blocking activity, as well as nonselective β activity, such as Labetalol or carvedilol. In low doses, labetalol and carvedilol can decrease the peripheral resistance and block the effects of isoprenaline to reduce hypertensive symptoms.
Pheochromocytoma
Pheochromocytoma is a disease in which a catecholamine secreting tumor develops. Specifically, norepinephrine and epinephrine are secreted by these tumors, either continuously or intermittently. The excess release of these catecholamines increases central nervous system stimulation, thus causing blood vessels to increase in vascular resistance, and ultimately giving rise to hypertension. In addition, patients with these rare tumors are often subject to headaches, heart palpitations, and increased sweating.
Phenoxybenzamine, a nonselective α1 and α2 blocker, has been used to treat pheochromocytoma. This drug blocks the activity of epinephrine and norepinephrine by antagonizing the alpha receptors, thus decreasing vascular resistance, increasing vasodilation, and decreasing blood pressure overall.