Wednesday, February 12, 2014

Review Backs Use of Prazosin for PTSD-Related Nightmares

Off-label use of prazosin to manage nightmares in veterans with combat-related posttraumatic stress disorder received a boost with publication of a critical review in the Journal of Neuropsychiatry and Clinical Neuroscience. Use of antidepressants to alleviate PTSD-related nightmares has shown little benefit.

The examination of seven published studies on prazosin, an alpha adrinergic antagonist long used to treat high blood pressure, included 210 patients, 95 percent male, and veterans of conflicts from World War II to Iraq and Afghanistan.

Two randomized, controlled trials reported positive effects on reducing nightmares. One other showed a negative effect, but “nightmare intensity was not properly measured” in that study, wrote Brian Writer, D.O., Eric Meyer, M.D., and Jason Schillerstrom, M.D., of the Department of Psychiatry at Wilford Hall Ambulatory Surgical Center in San Antonio, Texas. In addition, one retrospective chart review and three open-label trials yielded positive results across a range of ages, said the authors. When prazosin was discontinued, the nightmares returned but resolved again when the drug was restarted.

“[G]iven the sobering morbidity and frequency of combat-related PTSD nightmares in conjunction with the available positive evidence-base signal, this review highlights an indication for further randomized, controlled examination of prazosin, specifically in the combat-PTSD cohort,” concluded the authors.

For more in Psychiatric News about prazosin and nightmares, see “Conquering Vets' Nightmares Diminishes PTSD Symptoms.” For a recent report in the American Journal of Psychiatry, see: "A Trial of Prazosin for Combat Trauma PTSD With Nightmares inActive-Duty Soldiers Returned From Iraq and Afghanistan."

(Image: Katalinks/


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