Prazosin treatment of nightmares related to posttraumatic stress disorder

Objective: To describe current data evaluating the use of prazosin in adults with posttraumatic stress disorder (PTSD) who are experiencing nightmares. Data Sources: A literature search using MEDLINE (1966-March 2007) and the Published International Literature on Traumatic Stress database (1982-March 2007) was conducted using the search terms a-antagonist, a-blocker, prazosin, and posttraumatic stress disorder. References of identified articles were reviewed for additional citations. Study Selection and Data Extraction: All English-language articles regarding the use of prazosin in adults with nightmares related to PTSD were reviewed. Data Synthesis: PTSD is a psychiatric disorder that develops in some people after exposure to trauma. Sleep disturbances occur in up to 70% of patients with PTSD. Several neurotransmitters have been implicated in the pathophysiology of sleep disturbances in PTSD. Adrenergic agents that inhibit norepinephrine, such as prazosin, may decrease the arousal produced by norepinephrine in response to a stressor. Four open-label studies, 1 retrospective chart review, and 2 placebo-controlled trials reporting the use of prazosin for nightmares related to PTSD were reviewed. All studies included a small number of patients (4-59) and evaluated prazosin dosages ranging from 1 to 20 mg/day. Despite various limitations, all of the studies showed significant improvements in the sleep-related symptoms of PTSD following the addition of prazosin therapy, based on the Clinician Administered PTSD Scale recurrent distressing dreams item and the Clinical Global Impression of Change scale. Conclusions: Prazosin appears to be a promising and fairly well tolerated agent for the management of PTSD-related nightmares and sleep disturbances. Further well designed trials are warranted to establish its place in therapy.