Trial of prazosin for PTSD in military veterans

A trial involving military veterans with chronic post-traumatic stress disorder (PTSD) has found that prazosin did not help to alleviate distressing dreams or boost sleep quality. The research, funded by the Department of Veterans Affairs Cooperative Studies Program, randomized 304 participants to receive prazosin, an alpha1-adrenoreceptor antagonist, or placebo for 26 weeks. The drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women, and after week 10, the participants continued to receive prazosin or placebo in a double-blind fashion for another 16 weeks. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the three main outcome measures: the Clinician-Administered PTSD Scale item B2 (recurrent distressing dreams), the Pittsburgh Sleep Quality Index, and the Clinical Global Impression of Change. There were also no significant differences in these measures at 26 weeks, nor in other secondary outcomes. Participants in the prazosin group had significantly greater reductions in supine and standing systolic and diastolic blood pressure compared with the placebo group at 10 weeks. The number of serious adverse events did not differ significantly by group, although new or worsening suicidal ideation was less common among participants in the prazosin group than among those in the placebo group. "The current results notwithstanding, previous single-site trials of prazosin have shown that there may be veterans with PTSD of many years' duration who derive a benefit from prazosin with respect to trauma-related nightmares, sleep disruption, and daytime hyperarousal symptoms," the researchers conclude. "Further studies with more refined characterization of autonomic nervous system activity and nocturnal behaviors are needed to determine whether there might be subgroups of veterans with PTSD who can benefit from prazosin."