The alpha(1)-adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: A report of 4 cases

Background: Central nervous system (CNS) adrenergic hyperresponsiveness may be involved in the pathophysiology of posttraumatic stress disorder (PTSD) . Two Vietnam combat veterans with PTSD prescribed the centrally active alp ha(1)-adrenergic antagonist prazosin for symptoms of benign prostatic hyper trophy unexpectedly reported elimination of combat trauma nightmares. This observation prompted an open-label feasibility trial of prazosin for combat trauma nightmares in chronic combat-induced PTSD. Method: Four consecutively identified combat veterans with chronic DSM-IV P TSD and severe intractable combat trauma nightmares participated in an 8-we ek open trial of escalating-dose prazosin. Nightmare severity response was rated using the nightmare item of the Clinician Administered PTSD Scale and the Clinical Global Impressions-Change scale. Results: The 2 patients who achieved a daily prazosin dose of at lease 5 mg were markedly improved, with complete elimination of trauma nightmares and resumption of normal dreaming. The 2 subjects limited to 2 mg of prazosin to avoid excessive blood pressure reduction were moderately improved with a t least 50% reduction in nightmare severity. Conclusion: These clinical observations, together with neurobiological evid ence for alpha(1)-adrenergic regulation of CNS neurobiological systems rele vant to PTSD, provide rationale for placebo-controlled trials of prazosin f or PTSD combat trauma nightmares.