The α₁-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder.

Notes that heightened noradrenergic reactivity may be a contributing factor in the pathophysiology of posttraumatic stress disorder (PTSD). Prazosin is an α₁ adrenoceptor antagonist commonly used as an antihypertensive agent. Five outpatients (aged 35-58 yrs) with non-combat related PTSD were consecutively identified and received prazosin in a 6-wk open-label trial. In each case, the prazosin doses were slowly increased until optimal benefit was achieved. Change was assessed with the Clinician-Administered PTSD Scale for DSM-IV, One Week Symptom Version (CAPSSX), the Clinical Global Impression of Change Scale (CGIC), and the Clinical Impression of ChangeNightmares (CIC-Nightmares) score. All 5 patients experienced moderate to marked improvement on the CGIC. The CAPS-SX PTSD nightmare and sleep PTSD categories showed at least a 4 point reduction of those symptoms. All patients reported at least moderate improvement on the CIC-Nightmare score. Optimal doses of prazosin ranged from 1 to 4 mg/day. The drug was reasonably tolerated, and there were no drug discontinuations.These preliminary findings provide a rationale for blind placebo-controlled efficacy trials of the α₁ antagonist prazosin for PTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved)