Prazosin for nightmares

Prazosin for nightmares

by Dale Wong -

Reading this week's articles on the efficacy of Prazosin with patients suffering from PTSD was quite an interesting one. I was quite surprised that Prazosin wasn't effective given the research conducted with the military population. However, other research has shown some promise with the utilization of prazosin in treating PTSD-associated nightmares (Espinel, Kung, & Lapid, 2012). Even so, studies are limited, but promising in that regard. Furthermore, the research conducted on such topics usually extend to one type of population. For that reason, more research needs to be conducted with a wider variety of individuals (adolescents, adults, women, etc.). Research with one given population isn't enough to discredit one type of medication.

According to one article, PTSD increases the risk of cardiovascular diseases and stroke. This, in turn, predisposes individuals to certain conditions, such as hypertension, hyperlipidemia, and obesity (Coughlin, 2013). In relation to this, prazosin is an antihypertensive and has been shown to reduce blood pressure by 6.7 mm Hg according to the article posted from the New England Journal of Medicine (this week's reading). The point is, although the article discovered that prazosin did not alleviate distressing dreams or improve one's sleep quality, it can reduce the risk of cardiovascular diseases associated with chronic PTSD.  Since nightmares are associated with an increased risk of suicide attempts, there exists the need for protective factors that can reduce the risk of suicide attempts for those who may suffer from chronic nightmares. 

Coughlin, S. S. (2013). Post-Traumatic stress disorder and cardiovascular disease. The Open Cardiovascular Medicine Journal, 5. doi:10.2105/9780875530161ch07

Espinel, Z., Kung, S., & Lapid, M. (2012). reatment of nightmares with prazosin: a systematic review. European Psychiatry, 27. doi:10.1016/s0924-9338(12)75261-6

Raskind, M.A., Peskind, E.R., Chow, B., Harris, C., Davis-Karim, A., Homes, H.A….& Romesser, J. (2018). Trial of prazosin for post-traumatic stress disorder in military veterans. New England Journal of Medicine, 378(6), 507-517.

Titus, C. E., Speed, K. J., Cartwright, P. M., Drapeau, C. W., Heo, Y. & Nadorff, M. R. (2018) “What role do nightmares play in suicide? A brief exploration.” Current Opinion in Psychology.

Re: Prazosin for nightmares

by Rene -

Hello Everyone,

If you didn’t know I’m a military Veteran, USAF specifically and I’ve worked with many of my brothers and sisters in uniform suffering with PTSD.  I have a strong interest in working with them when I finish my education.  This week’s Journal club was very informative, and shocking as someone put in their post.  Currently my clinical rotations are at Travis Air Force Base (AFB) and working in the Mental Health Clinic I see how often Prazosin is prescribed to patients with PTSD for nightmares, it’s prescribed almost every single time.  So I too was shocked to find that this study conducted by the VA found that Prazosin is not effective at treating nightmares in patients with PTSD.  I searched the internet and found some research opposing this articles research findings

Raskind (2018) states, “Prazosin is an inexpensive, clinically available and brain active drug that reduces brain noradrenergic activity by antagonizing the effects of norepinephrine at the postsynaptic alpha-1 adrenoreceptor”.  By working on these receptors Prazosin has been proven to inhibit nightmares in individuals with PTSD.  Prazosin should be initiated as an adjunctive treatment to promote sleep in those suffering from PTSD nightmares, and it should be started at 1mg and then titrated up until the absence or the desired reduction of nightmares is achieved, with a max dose recommendation of 20mg at bedtime (Breen, Blankley, & Fine (2017).  According to Singh et al. (2016), the study found that prazosin improves nightmare symptoms and PTSD symptoms overall, including hyperarousal, other sleep disturbances, total sleep time, and the quality of sleep.  From talking to my patients about how the medications are working for them in interviews I found that more patients feel that prazosin does help them sleep better and reduce the incidence of nightmares.  In the end of the article we are responding to the authors stated that the study had some limitations, including the possibility of recruitment bias.  I’m interested to read more research on the subject.

 

References

Breen, A., Blankley, K., & Fine, J. (2017). The efficacy of prazosin for the treatment of posttraumatic stress disorder nightmares in U.S. military veterans. Journal of the American Association of Nurse Practitioners, 29(2), 65-69. 10.1002/2327-6924.12432 Retrieved from https://ucsf.idm.oclc.org/login?url=http://dx.doi.org/10.1002/2327-6924.12432

Raskind, M. A. (2018). Pharmacology of sleep and PTSD: Prazosin - an alpha-1 adrenoreceptor antagonist approach to post-traumatic stress disorder pharmacotherapy. In E. Vermetten, A. Germain & T. C. Neylan (Eds.), Sleep and combat-related post traumatic stress disorder (pp. 349-359). New York, NY: Springer New York.10.1007/978-1-4939-7148-0_30 Retrieved from https://ucsf.idm.oclc.org/login?url=https://doi.org/10.1007/978-1-4939-7148-0_30

Singh, B., Hughes, A. J., Mehta, G., Erwin, P. J., & Parsaik, A. K. (2016). Efficacy of prazosin in posttraumatic stress disorder: A systematic review and meta-analysis. LID - 10.4088/PCC.16r01943 doi]