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Journal of Psychiatric Practice Jul 2014Posttraumatic stress disorder (PTSD) often follows a chronic course, and the disorder is resistant to treatment with antidepressants and cognitive-behavioral therapy in... (Review)
Review
Posttraumatic stress disorder (PTSD) often follows a chronic course, and the disorder is resistant to treatment with antidepressants and cognitive-behavioral therapy in a proportion of patients. Prazosin, an a1-adrenoceptor blocker, has shown some promise in treating chronic PTSD. A review of this literature was conducted via a search of MEDLINE and SUMMON, using keywords such as PTSD, prazosin, treatment, and resistance. At least 10 clinical studies of prazosin in the treatment of PTSD, including open-label and randomized controlled trials, have been published. All of these studies support the efficacy of prazosin either for treating nightmares and improving sleep or for reducing the severity of PTSD. Treatment of PTSD with prazosin is usually initiated at a dose of 1 mg, with monitoring for hypotension after the first dose. The dose is then gradually increased to maintenance levels of 2-6 mg at night. Studies of military patients with PTSD have used higher doses (e.g., 10-16 mg at night). Prazosin has also been studied in younger and older adults with PTSD and in patients with alcohol problems, in whom it was found to reduce cravings and stress responses. Prazosin offers some hope for treating resistant cases of PTSD in which recurrent nightmares are problematic, with a relatively rapid response within weeks. It is suggested that large-scale civilian trials of prazosin be done, as well as studies concerning the use of prazosin in acute PTSD and as a potential preventive agent.
Topics: Adolescent; Adrenergic alpha-1 Receptor Antagonists; Adult; Humans; Prazosin; Stress Disorders, Post-Traumatic
PubMed: 25036580
DOI: 10.1097/01.pra.0000452561.98286.1e -
Giornale Italiano Di Cardiologia 1979
Review
Topics: Administration, Oral; Humans; Hypertension; Prazosin; Protein Binding; Quinazolines
PubMed: 385411
DOI: No ID Found -
The New England Journal of Medicine Feb 1979
Review
Topics: Animals; Binding Sites; Dogs; Heart Failure; Humans; Hypertension; Prazosin; Quinazolines; Rats; Vasomotor System
PubMed: 366403
DOI: 10.1056/NEJM197902013000505 -
CNS Drugs Jul 2022Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in... (Review)
Review
Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.
Topics: Dreams; Humans; Prazosin; Sleep; Sleep Wake Disorders; Stress Disorders, Post-Traumatic
PubMed: 35688992
DOI: 10.1007/s40263-022-00929-x -
Journal of the American Association of... Feb 2017Nightmares associated with posttraumatic stress disorder (PTSD) are a hallmark symptom among U.S. military veterans who have seen combat. Management of combat-related... (Review)
Review
BACKGROUND AND PURPOSE
Nightmares associated with posttraumatic stress disorder (PTSD) are a hallmark symptom among U.S. military veterans who have seen combat. Management of combat-related nightmares can be difficult and current pharmacologic options are limited and tend to have adverse side effects. The aim of this review is to explore recent literature regarding the efficacy of prazosin for the treatment of nightmare disorder in the veteran population.
METHODS
Recent literature consisting of three systematic reviews was reviewed, as well as current clinical guidelines published by The Department of Veterans Affairs (VA) and The Department of Defense (DoD) and the American Academy of Sleep Medicine (AASM).
CONCLUSIONS
Prazosin has been shown to be effective in the treatment of PTSD trauma-related nightmares. As a result of its low side effect profile and abilities to improve both sleep and reduce trauma nightmares, prazosin has been recommended as an adjunct therapy.
IMPLICATIONS FOR PRACTICE
Prazosin should be initiated as an adjunctive treatment to promote sleep in those suffering from PTSD nightmares. It should be initiated at 1 mg and then titrated upward until absence or desired reduction of nightmares is achieved, with a maximum dosage recommendation of 20 mg at bedtime and 5 mg midmorning.
Topics: Dreams; Humans; Prazosin; Sleep; Stress Disorders, Post-Traumatic; Treatment Outcome; United States; Veterans
PubMed: 27977074
DOI: 10.1002/2327-6924.12432 -
Canadian Journal of Psychiatry. Revue... Mar 2017The present review aims to assess the clinical efficacy and safety of the α-1-adrenergic antagonist prazosin as primary pharmacologic treatment for post-traumatic... (Review)
Review
OBJECTIVE
The present review aims to assess the clinical efficacy and safety of the α-1-adrenergic antagonist prazosin as primary pharmacologic treatment for post-traumatic stress disorder (PTSD).
METHOD
A systematic review was performed using keywords (i.e., prazosin, α-1-adrenergic antagonist, α-1-blocker, post-traumatic stress disorder) in the databases PubMed/Medline (1966-May 2016), Embase (1966-May 2016), ScienceDirect (1823-May 2016), OvidSP (1946-May 2016) and Nature (1845-May 2016). To be considered for inclusion, studies had to test the efficacy of prazosin either alone or added to ongoing treatment in adults with PTSD, use validated tools to assess and monitor the disorders, allow comparisons on the basis of univariate analyses (i.e., p-values of t-tests and effect sizes) and list the identified adverse reactions.
RESULTS
12 studies were included: 5 randomized controlled trials, 4 open-label prospective trials and 3 retrospective file reviews. The evaluation concerned 276 patients exposed to civilian trauma (19%) or war trauma (81%). Prazosin significantly decreases trauma nightmares, avoidance, hypervigilance and improves patient status in all studies. No significant difference of blood pressure was observed at the end of trials.
CONCLUSIONS
Beyond the methodological and clinical biases of these studies, the present review not only confirms the effectiveness and good tolerability of prazosin, but also suggests its possible use as primary pharmacologic treatment for PTSD. Uncertainties remain, however, regarding the prescription modalities and dosages.
Topics: Adrenergic alpha-1 Receptor Antagonists; Humans; Prazosin; Stress Disorders, Post-Traumatic
PubMed: 27432823
DOI: 10.1177/0706743716659275 -
Sleep Medicine Reviews Apr 2020Pharmacological treatment with prazosin and psychological treatment with imagery rehearsal therapy (IRT) are the two main treatments of posttraumatic nightmares. The... (Meta-Analysis)
Meta-Analysis Review
Pharmacological treatment with prazosin and psychological treatment with imagery rehearsal therapy (IRT) are the two main treatments of posttraumatic nightmares. The American Academy of Sleep Medicine task force recently listed IRT as the recommended treatment for trauma-related nightmares and changed the recommendation of prazosin to 'may be used'. This new recommendation was based on a single prazosin trial and not on a meta-analytic review of all available trials. The current meta-analysis aims to fill this gap in the literature. Eight studies on IRT and seven studies on prazosin (N = 1.078) were analyzed based on the random effects model. Relative to control groups, prazosin had a moderate to large effect on nightmare frequency (g = 0.61), posttraumatic stress symptoms (g = 0.81), and sleep quality (g = 0.85). IRT showed small to moderate effects on nightmare frequency (g = 0.51), posttraumatic symptoms (g = 0.31), and sleep quality (g = 0.51). No significant differences in effect were observed between prazosin and IRT on any of these outcomes (all p's > 0.10). It is concluded that downgrading the recommendation of prazosin may be a premature decision and that the aggregated results in this meta-analysis clearly show efficacy of both treatments.
Topics: Adrenergic alpha-1 Receptor Antagonists; Dreams; Humans; Imagery, Psychotherapy; Prazosin; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic
PubMed: 31855732
DOI: 10.1016/j.smrv.2019.101248 -
Canadian Medical Association Journal Feb 1978
Topics: Drug Therapy, Combination; Humans; Prazosin; Quinazolines
PubMed: 630494
DOI: No ID Found -
Drugs Apr 1983Prazosin is an orally active post-synaptic selective alpha 1-adrenoreceptor antagonist that has been widely used in treating hypertension and congestive heart failure... (Clinical Trial)
Clinical Trial Review
Prazosin is an orally active post-synaptic selective alpha 1-adrenoreceptor antagonist that has been widely used in treating hypertension and congestive heart failure (CHF). Its role in the treatment of hypertension has previously been reviewed in this journal. Subsequent reports confirm its efficacy in treating mild to severe hypertension as a single agent or, more frequently, in combination with another antihypertensive agent and/or a diuretic. Recent studies of the metabolic effect of prazosin indicate that the drug may have a favourable effect on plasma lipids in hypertensive patients. Its recent use in treatment of congestive heart failure has shown prazosin to be comparable with nitroprusside in producing balanced arterial and venous dilation with generally sustained haemodynamic and clinical effects during long term therapy. Initial studies in Raynaud's phenomenon and in patients with aortic regurgitation or aortic stenosis or with mitral regurgitation are promising, but require confirmation from wider clinical experience. The drug has generally been well tolerated. The primary side effect of orthostatic hypotension can be largely avoided by beginning treatment with a low dose.
Topics: Adrenergic alpha-Antagonists; Blood Pressure; Cardiovascular Diseases; Clinical Trials as Topic; Heart Failure; Heart Rate; Hemodynamics; Humans; Hypertension; Kidney; Lipid Metabolism; Prazosin; Quinazolines; Regional Blood Flow; Renin-Angiotensin System
PubMed: 6303744
DOI: 10.2165/00003495-198325040-00002 -
British Medical Journal Nov 1976
Clinical Trial Comparative Study
Topics: Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Humans; Hypotension, Orthostatic; Male; Prazosin; Quinazolines
PubMed: 791450
DOI: 10.1136/bmj.2.6046.1257-b