A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan.

Abstract

OBJECTIVE:

The authors conducted a 15-week randomized controlled trial of the alpha-1 adrenoreceptor antagonist prazosin for combat trauma nightmares, sleep quality, global function, and overall symptoms in active-duty soldiers with posttraumatic stress disorder (PTSD) returned from combat deployments to Iraq and Afghanistan.

METHOD:

Sixty-seven soldiers were randomly assigned to treatment with prazosin or placebo for 15 weeks. Drug was titrated based on nightmare response over 6 weeks to a possible maximum dose of 5 mg midmorning and 20 mg at bedtime for men and 2 mg midmorning and 10 mg at bedtime for women. Mean achieved bedtime doses were 15.6 mg of prazosin (SD=6.0) and 18.8 mg of placebo (SD=3.3) for men and 7.0 mg of prazosin (SD=3.5) and 10.0 mg of placebo (SD=0.0) for women. Mean achieved midmorning doses were 4.0 mg of prazosin (SD=1.4) and 4.8 mg of placebo (SD=0.8) for men and 1.7 mg of prazosin (SD=0.5) and 2.0 mg of placebo (SD=0.0) mg for women. Primary outcome measures were the nightmare item of the Clinician-Administered PTSD Scale (CAPS), the Pittsburgh Sleep Quality Index, and the change item of the Clinical Global Impressions Scale anchored to functioning. Secondary outcome measures were the 17-item CAPS, the Hamilton Depression Rating Scale, the Patient Health Questionnaire-9, and the Quality of Life Index. Maintenance psychotropic medications and supportive psychotherapy were held constant.

RESULTS:

Prazosin was effective for trauma nightmares, sleep quality, global function, CAPS score, and the CAPS hyperarousal symptom cluster. Prazosin was well tolerated, and blood pressure changes did not differ between groups.

CONCLUSIONS:

Prazosin is effective for combat-related PTSD with trauma nightmares in active-duty soldiers, and benefits are clinically meaningful. Substantial residual symptoms suggest that studies combining prazosin with effective psychotherapies might demonstrate further benefit.

• Authors: Murray A Raskind, Kris Peterson, Tammy Williams, David J Hoff, Kimberly Hart, Hollie Holmes, Dallas Homas, Jeffrey Hill, Colin Daniels, Jess Calohan, Steven P Millard, Kirsten Rohde, James O'Connell, Denise Pritzl, Kevin Feiszli, Eric C Petrie, Christopher Gross, Cynthia L Mayer, Michael C Freed, Charles Engel, Elaine R Peskind
• Journal: The American journal of psychiatry (Am J Psychiatry) Vol. 170 Issue 9 Pg. 1003-10 (Sep 2013) ISSN: 1535-7228 [Electronic] United States
• PMID: 23846759 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Adrenergic alpha-1 Receptor Antagonists
• Prazosin

Topics

• Activities of Daily Living
• Adrenergic alpha-1 Receptor Antagonists (administration & dosage, adverse effects)
• Adult
• Behavioral Symptoms (drug therapy)
• Combat Disorders (diagnosis, drug therapy, psychology)
• Combined Modality Therapy
• Dose-Response Relationship, Drug
• Dreams (drug effects, psychology)
• Drug Monitoring
• Female
• Humans
• Male
• Prazosin (administration & dosage, adverse effects)
• Psychiatric Status Rating Scales
• Psychotherapy
• Quality of Life
• Treatment Outcome