The efficacy of prazosin for the treatment of posttraumatic stress disorder nightmares in U.S. military veterans

Abstract

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.

Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

“…Although sleep loss is inherent to operational missions, chronic sleep loss is also prevalent among non-deployed SMs. Military personnel report sleep disturbances (e.g., insufficient or non-restorative sleep, insomnia, nightmares) before, during, and after deployment at alarming rates (Breen, Blankley, & Fine, 2017;Caldwell, Knapik, & Lieberman, 2017;de Dassel, Wittmann, Protic, Hollmer, & Gorzka, 2017;Troxel et al, 2015). Numbers have continuously grown over the years and have well surpassed prevalence and incidence rates of the general population.…”

Using Prazosin to Treat Posttraumatic Stress Disorder and Associations: A Systematic Review

“…It should be started at 1 mg and titrated upward until the desired absence or reduction of nightmares is attained, with a maximum dosing recommendation of 20 mg at bedtime and 5 mg in the middle of the morning. 40 A review paper evaluated the clinical efficacy and safety of prazosin as the primary pharmacological treatment for PTSD. As a criterion for inclusion, studies had to test the efficacy of prazosin alone or added to ongoing treatment in adults with PTSD using validated tools to assess and monitor disorders, allow comparisons based on univariate analyses, and highlight identified adverse reactions.…”

“…Prazosin should be started as an adjuvant treatment to promote sleep in those with PTSD nightmares. It should be started at 1 mg and titrated upward until the desired absence or reduction of nightmares is attained, with a maximum dosing recommendation of 20 mg at bedtime and 5 mg in the middle of the morning [ 40 ].…”

α 2-Adrenoceptors: Challenges and Opportunities—Enlightenment from the Kidney

“…Propranolol [66][67][68][69], prazosin [70][71][72], and combinations thereof [68] are widely used drugs for treatment of PTSD. Even so, management of PTSD remains problematic, and novel pharmacotherapies are badly needed.…”