Prazosin for Vets + Nightmares

Prazosin for Vets + Nightmares

by Marlene Thompson -

During yesterday's session of the Interprofessional Psychiatric Journal Club, we discussed an article published recently in The New England Journal of Medicine regarding Prazosin for the treatment of PTSD in veterans. We discussed the history of Prazosin's usage; originally it was formulated as a blood pressure medication and it was found to cross the blood brain barrier far easier than other blood pressure medications. We know that, in order for psychiatric medications to be useful (not surprisingly), they need to pass the blood brain barrier (think about the organ we're trying to target). For this reason, Prazosin was efficacious for treating psychiatric conditions, especially nightmares for those with PTSD. We also discussed why the article we reviewed was so significant--it was longitudinal and therefore provided more robust evidence than past studies for the long-term benefit of Prazosin. We also talked about how this study's population (veterans receiving care through the VA) was similar to the patient populations that we all see in our clinical settings. One topic that I would have enjoyed discussing more is the efficacy of using Prazosin in child patients. In my clinical experiences, I have worked with children and adolescents that have experienced repeated traumas and suffer from complex PTSD. These patients suffer from regular nightmares and I would be interested in using Prazosin, however, I worry about the limited literature for this population. More food for thought and more potential for research...

As always, it was a treat to collaborate with our pharmacy colleagues in reaching a deeper understanding of this useful medication!

Re: Prazosin for Vets + Nightmares

by Diane Kim -
Hi Marlene, Thanks for your post. 


I appreciated how you summarized the discussion from class in a clear, concise, and informative way. I too, am curious about the use of prazosin in children and adolescents. 

A 2017 literature review validated your concerns, stating that prazosin has not been well studied in children, but that it shows favorable outcomes. Akinsanya, Marwaha, and Tampi (2016) stated that in their literature search, several of the articles found were case reports. One of these reports discussed an adolescent female with a history of neglect, physical and sexual abuse, and foster home placement. She exhibited signs and symptoms of PTSD (nightmares, difficulty sleeping, hypervigilance), depression, and anxiety. She was being treated with various medications, including nefazodone, trazodone, ambien, and mirtazapine – a combination of medications that was ineffective in addressing her symptoms. She was admitted to a long-term psychiatric facility and these medications were stopped. Prazosin was started and titrated appropriately, and within weeks, she showed significant improvement in her overall symptoms, including no nightmares and better sleep. It is important to note, however, that she also was doing therapy (group and individuals), which could have also had a positive impact on her psychological outcomes. Regardless, the fact that her nightmares stopped within several weeks is quite promising. Case reports like this provide much hope regarding the potential of utilizing prazosin with children and adolescents more routinely in clinical practice. 


Akinsanya, A., Marwaha, R., & Tampi, R. R. (2017). Prazosin in Children and Adolescents With Posttraumatic Stress Disorder Who Have Nightmares: A Systematic Review. Journal of clinical psychopharmacology, 37(1), 84-88.