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Prazosin in the Treatment of PTSD


Journal of Psychiatric Practice®: July 2014 - Volume 20 - Issue 4 - p 253–259
doi: 10.1097/01.pra.0000452561.98286.1e

Posttraumatic stress disorder (PTSD) often follows a chronic course, and the disorder is resistant to treatment with antidepressants and cognitive-behavioral therapy in a proportion of patients. Prazosin, an a1-adrenoceptor blocker, has shown some promise in treating chronic PTSD. A review of this literature was conducted via a search of MEDLINE and SUMMON, using keywords such as PTSD, prazosin, treatment, and resistance. At least 10 clinical studies of prazosin in the treatment of PTSD, including open-label and randomized controlled trials, have been published. All of these studies support the efficacy of prazosin either for treating nightmares and improving sleep or for reducing the severity of PTSD. Treatment of PTSD with prazosin is usually initiated at a dose of 1 mg, with monitoring for hypotension after the first dose. The dose is then gradually increased to maintenance levels of 2–6 mg at night. Studies of military patients with PTSD have used higher doses (e.g., 10–16 mg at night). Prazosin has also been studied in younger and older adults with PTSD and in patients with alcohol problems, in whom it was found to reduce cravings and stress responses. Prazosin offers some hope for treating resistant cases of PTSD in which recurrent nightmares are problematic, with a relatively rapid response within weeks. It is suggested that large-scale civilian trials of prazosin be done, as well as studies concerning the use of prazosin in acute PTSD and as a potential preventive agent. (Journal of Psychiatric Practice 2014;20:253–259)

GREEN: University of Chester, Chester, UK

The author declares no conflicts of interest.

Please send correspondence to: Ben Green, FRCPsych, MB, ChB, Professor of Psychiatry and a Director of the Institute of Medicine, University of Chester, Parkgate Rd, Chester, CH1 4BJ.

© 2014 by Lippincott Williams & Wilkins, Inc.