Prazosin Reduces Nightmares in Combat Veterans With Posttraumatic Stress Disorder
J Clin Psychiatry 2002;63:565-568
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Preclinical and clinical observations suggest that
the centrally active alpha1-adrenergic antagonist prazosin might
alleviate trauma content nightmares and other symptoms in combat veterans with
chronic posttraumatic stress disorder (PTSD).
Method: In this retrospective chart
review study, we analyzed data from 59 consecutive combat veterans with previously
treatment-resistant chronic PTSD (DSM-IV criteria) and
severe intractable trauma content nightmares to
whom prazosin had been prescribed. Nightmare
severity was quantified using the recurrent
distressing dreams item of the Clinician Administered
PTSD Scale (CAPS). Change in overall PTSD severity exclusive of nightmares was estimated by
assigning a Clinical Global Impressions-Change
scale (CGI-C) score based on chart review.
Results: Mean ± SEM recurrent
distressing dreams item scores improved significantly (7.0
± 0.2 to 3.5 ± 0.3, p < .0001) in the 36 patients
who completed at least 8 weeks of prazosin
treatment at their maximum titrated dose. The mean
maximum prazosin dose achieved in these 36
patients was 9.6 ± 0.9 mg/day. Recurrent
distressing dreams scores also improved in the total
group who filled their prazosin prescriptions (N =
51) (7.1 ± 0.2 to 4.2 ± 0.3, p < .0001). In a
comparison group of 8 patients who did not fill their
prazosin prescriptions but continued in outpatient treatment, there was no significant change
in CAPS recurrent distressing dreams score (6.8
± 0.5 to 6.7 ± 0.4). There also was at least
some improvement in CGI-C ratings of overall PTSD severity exclusive of nightmares in a
substantial majority of patients receiving prazosin, but not
in the 8 comparison subjects. There were no
serious adverse effects attributable to prazosin.
Conclusion: These observations suggest
that prazosin may relieve symptomatic distress in PTSD, and they provide rationale for
placebo-controlled trials of prazosin for PTSD
trauma content nightmares and other PTSD symptoms.