Prazosin Treats Nightmares in Post-Traumatic Stress Disorder (PTSD)

Blocking the Stress Hormone Norepinephrine May Help Sleep, Insomnia

Prazosin is a prescription medication useful for the treatment of stress-related nightmares and insomnia in PTSD
Prazosin is a prescription medication useful for the treatment of stress-related nightmares and insomnia in PTSD. Andy Sotiriou/Stone/Getty Images

Physicians prescribe prazosin, sold under the brand name of Minipress, to treat nightmares for post-traumatic stress disorder (PTSD). Oddly enough, this medication does not seem to be effective in patients with non-PTSD nightmares.

How Common Is Post-Traumatic Stress Disorder (PTSD)?

Historically, only veterans coming home from combat were diagnosed with PTSD. Now, clinicians recognize patients who experience other types of traumatic events can also suffer from this debilitating mental condition.

About 8 percent of men and 20 percent of women who experience a traumatic event themselves or watch one happen as a non-participant get PTSD. Aside from the triggering event, you must also develop four general symptoms to receive a diagnosis:

  1. Re-experiencing the event even though it's over
  2. Avoiding reminders of the trauma, including people, places, and objects
  3. Negative changes in your mood and thoughts associated with the triggering event
  4. Chronic hyperarousal symptoms, which make you feel stressed and angry

How Prazosin Works to Treat Nightmares

Prazosin blocks norepinephrine, a stress hormone that affects your brain, at specialized chemical receptors called alpha-1 receptors. Receptors are the sites where cells transmit messages to each other. It is not clear how this specifically impacts sleep or dreams.

Other Therapeutic Uses of Prazosin

Clinical studies show prazosin might offer other therapeutic benefits to PTSD patients, but the results are mixed.

Taking prazosin:

  • Significantly reduced daytime PTSD symptoms when military personnel already taking it took it in the daytime too.
  • Has a significant beneficial effect on alcohol cravings for participants who were alcohol dependent and trying to stop drinking. This is important when you consider the number of PTSD patients who turn to alcohol for comfort and end up with an alcohol use disorder.

    Who Should Not Use It

    There are only a few circumstances where you should not take prazosin or use with caution:

    • If you have previously had adverse reactions to this or similar medications, don't take prazosin.
    • If you've had cataract surgery, take prazosin with caution.

    Of course, your physician can help you determine whether these circumstances apply to your case.

    Common Side Effects of Prazosin

    Prazosin can cause side effects, including:

    • Drowsiness, in 8 percent of patients
    • Lack of energy, in 7 percent of patients
    • Weakness, in 7 percent of patients
    • Dizziness, in 10 percent of patients, and nausea in 5 percent of patients
    • Palpitations (irregular heartbeats), in 5 percent of patients
    • Headache, in 8 percent of patients

    Side effects of prazosin that occur in 1 to 4 percent of patients include:

    • Vomiting
    • Diarrhea and/or constipation
    • Orthostatic hypotension (a form of low blood pressure triggered by standing up from a seated position too quickly)
    • Depression
    • Nasal congestion
    • Fainting

    Safety Precautions

    As described above, certain people should use prazosin with caution or not at all. The safety of its use while pregnant or breastfeeding is not known, so use caution. It may be important to monitor your blood pressure with its use, so that it does not become too low and cause fainting or falls.

    A Word from Verywell

    If you experience any difficulties, you should be in close contact with your primary health care provider. PTSD is a serious condition and it deserves treatment. Don't suffer in silence: reach out to get the help that you need to sleep more normally. If you suffer from depression and experience thoughts of suicide, reach out for help by calling the toll-free suicide prevention hotline at 1-800-273-8255.

    Sources:

    Koola, et al. Therapeutic Advances in Psychopharmacology: High-dose prazosin for the treatment of post-traumatic stress disorder. (2014)

    "Prazosin." Epocrates Rx Pro. Version 16.3, 2016. Epocrates, Inc. San Mateo, California.

    Jeffrys, Matt, MD. U.S. Department of Veterans Affairs: Clinician's Guide to Medications for PTSD

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