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The Off-Label Use of Prazosin for Sleep Disturbances in Noncombat Posttraumatic Stress Disorder

14 August 2010


Background: Posttraumatic stress disorder (PTSD) is a form of anxiety disorder that arises after exposure to a traumatic event or stressor. It is characterized by persistent invasive thoughts, emotional detachment, hypervigilance and sleep disturbances. These sleep disturbances include nightmares, insomnia and distressed awakenings and are often refractory to multiple medications, including SSRIs, which are the only FDA approved medication for PTSD. Prazosin is an alpha-1 adrenergic antagonist that has been studied for use in nighttime symptoms of PTSD in civilian populations, however most data exists for its use in combat-related PTSD. This review examines the differences in these two populations and investigates the off-label use of prazosin for sleep disturbances in noncombat posttraumatic stress disorder.

Methods: Exhaustive search of available medical literature via MEDLINE, CINAHL, PILOTS, and PsychINFO databases using combinations of the terms PTSD, Stress Disorder, Prazosin, Alpha Antagonist and Alpha Blocker. Inclusion criteria were set to incorporate studies that used prazosin to treat nighttime symptoms of PTSD in a noncombat, non-military population. Exclusion criteria eliminated studies pertaining to combat PTSD, military or veteran population. Non peer-reviewed Letters to Editor were also excluded.

Results: Four studies, including one randomized control trial, one retrospective cohort, one case series and one case study were found.

Conclusion: Prazosin has potential as a treatment for the sleep disturbances of noncombat related PTSD. Both the prevalent female gender and heterogeneity of individual traumas in this civilian population were much different than previous trials and reviews that examined combat PTSD. While the demographics and experiences were diverse compared to the veteran population, the positive response to prazosin was similar to past findings. While larger, randomized and placebo-controlled trials are needed for FDA approval, the current off-label use of prazosin is demonstrated in the existing literature as efficacious.


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