A pilot study of the effect of terazosin on ATP levels in people with amyotrophic lateral sclerosis (TZ-ALS)

INCLUSION CRITERIA
*  Ages 18 - 80 years old
*  Diagnosed with ALS based on Gold Coast Criteria
*  ALS symptom onset within 36 months at enrollment
*  Slow vital capacity (SVC) \> 65%
*  Riluzole use-Never taken or taking a stable dose for at least 4 weeks prior to screening visit or will refrain from starting for the duration of the study
*  Edaravone use-Never taken or completed at least one cycle (typically 14 days) prior to screening visit or will refrain from starting for the duration of the study
*  Must have the ability to swallow pills at the time of the screening visit, and in the principle investigator's opinion, have the ability to swallow pills for the duration of the study
*  Willing to use highly effective contraception for the duration of the trial treatment and for a duration of 80 days after the last dose. EXCLUSION CRITERIA
*  Orthostatic hypotension at screening is defined as decrease in BP \> 20 mmHg systolic or \> 10 mmHg diastolic and HR increase \<20 bpm on transition from supine to sitting or from sitting to standing
*  Known allergy or previous adverse reaction to terazosin or related compound
*  Current use of terazosin or concurrent use of doxazosin, alfuzosin, prazosin, or tamsulosin at the time of screening visit or within the 3 months prior to baseline visit
*  Current diagnosis or healthcare professional-recommended treatment (medication, exercise or diet) of diabetes mellitus (type 1 or type 2)
*  Screening glucose \>140 mg/dl
*  Pregnancy or breastfeeding women
*  Taking therapeutic anticoagulant medication (i.e. warfarin, DOAC's, full dose Lovenox or heparin)
*  Liver function blood tests (ALT or AST) more than twice the upper limit of normal
*  Hemoglobin \< 11.0 g/dL
*  Traumatic brain injury or post-traumatic stress disorder
*  Presence of a confounding acute or unstable medical, psychiatric, or orthopedic condition
*  Noncompliant or sporadic use of medications that modulate the central nervous system
*  Uncontrolled major depression or bipolar affective disorder, or other mental health disorders that are, in the opinion of the PI, sufficiently severe to increase risk of experiencing an Adverse Drug Reaction (ADR)
*  Current suicidal ideation as measured by question 2 of the Columbia-Suicide Severity Rating Scale (C-SSRS)
*  Participants with insufficient decisional capacity to provide written informed consent determined by the primary investigator.
*  Noncompliant or sporadic use of antihypertensive medications
*  Unable to lie supine and still for 60 minutes for the duration of the study
*  Contraindications to undergoing lumbar puncture
*  Currently taking part in another clinical trial with an investigational medicinal product or having taken part in one in the three months prior to screening visit