Thursday, January 2, 2014

Prazosin for PTSD update

In this article by Raskind et al. in the American Journal of Psychiatry (Sep. 2013), combat veterans with PTSD were given prazosin or placebo in a 15 week randomized study:

The prazosin was substantially beneficial for PTSD symptoms.  Dosing was on average about 5 mg in the mid-morning + 15 mg at bedtime.

There was a large, clinically relevant,  sustained difference from placebo, and the prazosin was well-tolerated.

The experience from this study differs from my own experience prescribing this drug, in that the doses were much higher.  Also, they used daytime doses, which I think shows acknowledgment that prazosin is not just useful for nightmares, but for all symptoms of PTSD, day and night.    I had previously prescribed in the 1-2 mg range, but I see there is a lot of room to move to higher doses, which could be much more effective without major safety or side-effect risks.

No comments: