Just like most of my peers that have already posted, I was taken aback by the results found in the study "Trail of Prazosin for PTSD in Military Veterans" by Raskind et al. Every single PTSD patient I have come across or worked with had prazosin on their medication list. How can this study come out and say it is not effective? Does this mean we’ve been lied to all these years and patients have been paying the average retail price of $23.62 a month for a medication that does not have any significant effect for its intended purpose? It is a little hard for me to swallow. I can’t imagine telling our patients who have been on prazosin for years that this medication is in fact not helping with your nightmares and having been wasting money on it. This is why I did a little research to see if there are any other studies out there counteracting this 2018 study. Headaches, dizziness, drowsiness, tiredness, weakness, N/V/D are all some of the unpleasant side effects of prazosin, which is why most providers tend to not prescribe more than 16-20mg of prazosin, but a study published by Koola et al. found that increased doses of prazosin up to 30-45mg improved the overall outcome of PTSD symptoms including nightmares (2014). The researchers also reported that high doses of prazosin were safe, and tolerable for PTSD adults. Close monitoring in patients with low BP is however warranted (Koola et al., 2014). I would suggest that before Raskind et al. comes to a conclusion that shatter hopes or the effectiveness of a widely used medication, they can consider doing another study with increased doses of Prazosin. This is an opportunity for them to keep studying both PTSD symptoms and medications to treat them.
Koola, M. M., Varghese, S. P., & Fawcett, J. A. (2014). High-dose prazosin for the treatment of post-traumatic stress disorder. Therapeutic Advances in Psychopharmacology, 4(1), 43–47. https://ucsf.idm.oclc.org/login?url=http://doi.org/10.1177/2045125313500982
Raskind, M.A., Peskind, E.R., Chow, B., Harris, C., Davis-Karim, A., Holmes, H.A., Hart. K.L. et al, (2018) “Trail of Prazosin for PTSD in Military Veterans”, The New Englan Journal of Medicine. Vol 378(6) 507-517.