Prazosin for nightmares

Prazosin for nightmares

by Alexa -
I too was very surprised and disappointed that this study yielded Prazosin to be ineffective in reducing nightmares in patients with PTSD. I do not have much experience working with patients with nightmares, however, anecdotally, I have always heard from preceptors and colleagues that it has shown robust results in their patients. Although this article definitively states that Prazosin is ineffective, honestly, I likely will still use it in practice if I have a patient with nightmares that are distressing. I appreciated the journal club's discussion about the limitations of this study - particularly, its stringent exclusion criteria which ultimately reduces its generalizability. I also really appreciated the discussion/tip of Google-searching the author to discern whether or not the author works for the drug's pharmaceutical company, or has any other vested interest in the outcome of the study. This is something that I will incorporate into my practice when new articles arise in order to check and trust their validity. Great discussion! 

Re: Prazosin for nightmares

by Nana Efua Adabie -

Alexa,

I'm not surprised that you were also surprised by these findings. I too will most likely still use prazosin in practice for my PTSD patients, but this got me thinking; Playing the devil's advocate here... Am I that stuck in my ways that I don't want to move on or believe a study just because I am so used to a certain thing and have been using it for years without any complains? It reminds of the saying "If it ain't broken, don't fix it." For most of us that have seen prazosin used in clinical settings, we've seen our patients somewhat improve in their symptoms. So yes, it is hard to believe that it doesn't work, but maybe we should look at this as an opportunity to really do some more research and maybe come up with a better medication that truly targets the nightmare symptoms of PTSD?


Side note, I did find a study (It's in my original post) that Prazosin does work for nightmares when given in higher doses than 20mg. So I think we shouldn't give up on prazosin, but instead, experiment with higher doses and see if that makes any significant difference.

Thank you for your input!!