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Prazosin Calms Combat-Related Nightmares in Veterans
A DGReview of :"Prazosin reduces nightmares in combat veterans with posttraumatic stress disorder"
Journal of Clinical Psychiatry
08/06/2002
By Harvey McConnell
Prazosin can reduce the frequency of recurring nightmares among American combat veterans suffering from chronic posttraumatic stress disorder (PTSD).
Preclinical and clinical studies have suggested that prazosin, a centrally active alpha1-adrenergic antagonist, may alleviate the impact of nightmares related to combat, write researchers from the United States Veterans Administration Puget Sound Health Care System and University of Washington, in Seattle, Washington.
In their retrospective review, the clinicians analysed data from 59 consecutive combat veterans who had been prescribed prazosin. The patients had treatment-resistant chronic PTSD, which met Diagnostic and Statistical Manual of Mental Disorders Revision IV criteria, and severe intractable nightmares. The impact of the nightmares on the veterans was quantified by recurrent distressing dreams item of the Clinician Administered PTSD Scale (CAPS).
The 36 patients who maintained their prazosin treatment at the maximum titrated dose for at least eight weeks achieved significant improvement in their recurrent distressing dreams item scores (7.0 +/- 0.2 to 3.5 +/- 0.3, p<.0001). The mean maximum prazosin dose among these patients was 9.6 +/- 0.9 mg/day. Among the 51 patients who filled their prazosin prescriptions, recurrent distressing dreams scores also improved (7.1 +/- 0.2 to 4.2 +/- 0.3, p<.0001).
In a comparison group of eight patients who did not fill their prazosin prescriptions but continued in outpatient treatment, there was no significant change in CAPS recurrent distressing dreams score.
A large majority of patients receiving prazosin also had at least some improvement in Clinical Global Impressions-Change scale ratings of overall PTSD severity exclusive of nightmares. No such effect was seen among the eight comparison group patients.
No serious adverse effects could be attributed to use of prazosin, the researchers say.
Based on these findings, there should be placebo-controlled trials of prazosin for posttraumatic stress disorder (PTSD) associated nightmares and other PTSD symptoms, suggest the researchers.
J Clin Psychiatry 2002 Jul;63(7):565-8.
"Prazosin reduces nightmares in combat veterans with posttraumatic stress disorder"
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