Adjunctive prazosin helps battle nightmares in PTSD

Use of prazosin in the adjunctive setting shows some utility in reducing the frequency of nightmares in patients with post-traumatic stress disorder (PTSD) who are already receiving first-line treatment, according to a study.

Researchers used electronic records to collect data on previous prescriptions of prazosin in 84 veterans. Efficacy endpoints included nightmare frequency and clinical PTSD rating scales, while safety measures included adverse events such as altered blood pressure.

Following treatment with prazosin, the primary study outcome of nightmare frequency (item 2 of the PTSD checklist) dropped from 4.00 to 3.19 (on a scale of 1–5). The decrease was statistically significant (p<0.05).

Of note, average nightmare frequency was cut by half, from four times to two times per week (2.36, 95 percent confidence interval, 1.39–3.33; p=0.00002).

Out of the 84 patients included in the study, 23 showed the greatest response; 91 percent of them (n=21) were on an antidepressant and 61 percent (n=14) were undergoing concurrent psychotherapy. These numbers were higher relative to the 90-percent (n=76) and 44-percent (n=37) rates recorded in the total cohort, respectively.

There were no significant differences seen in blood pressure (p=0.58) or suicidal ideation (p=0.22).

An α₁-adrenergic antagonist, prazosin lowers the adrenergic response. Previous studies have shown that the α₁-receptor stimulation disrupts rapid eye movement (REM) sleep and increases non-REM sleep. As such, prazosin may help improve sleep and reduce nightmares associated with PTSD. [Prim Care Companion CNS Disord 2012;14:PCC.11r01222]