Patients with post-traumatic stress disorder (PTSD) are frequently symptomatic despite being medications currently

approved by the US Food and Drug Administration for PTSD. There is evidence to support the notion that prazosin is effective for PTSD nightmares. However, PTSD-related nightmares often do not resolve completely on a low dose of prazosin. The capacity of prazosin to treat daytime symptoms of PTSD which are distressing to patients has not been well studied. To date, the highest reported dose of prazosin used for PTSD is 16 mg daily. In a study entitled ‘A selleck inhibitor double-blind Placebo-controlled Trial of Prazosin for the Treatment of Inhibitors,research,lifescience,medical Alcohol Dependence’, the maximum dose was 16 mg which was achieved during a 2-week titration. Prazosin 16 mg was well tolerated and beneficial for pharmacologic treatment of alcohol

dependence [Simpson et al. 2009]. In a systematic review of 21 studies, consisting of four randomized controlled trials, four open-label studies, four retrospective chart Inhibitors,research,lifescience,medical reviews and nine case reports, the prazosin dose ranged from 1 to 16 mg daily. Overall, the studies showed that patients were able to tolerate 16 mg daily with dizziness as a common Inhibitors,research,lifescience,medical adverse effect. This systematic review found a small but positive evidence base to support the efficacy of prazosin therapy for nightmares. One of the objectives of this systematic review was to identify evidence for the use of prazosin to treat non-PTSD-related nightmares and they were not able to find any evidence to support it. However, there were several recent narratives of the use of prazosin to treat PTSD-related nightmares. The authors concluded Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical that prasozin is a well tolerated generically

available medication that has a small but positive evidence base for the treatment of PTSD-associated nightmares [Kung et al. 2012]. There are several ongoing clinical trials on high-dose prazosin use for PTSD (clinicaltrials.gov). In the randomized, double-blind trial ‘Prazosin and Combat Trauma in PTSD’, the prazosin maximum dose is 20 mg daily. In another study, ‘Efficacy of Adjunct Sleep Interventions for PTSD’, the maximum dose of prazosin is 15 mg daily. In ‘Prazosin for Noncombat Trauma PTSD’, the maximum dose used is 25 mg daily. The highest dose of prazosin used Non-specific serine/threonine protein kinase clinically is 50 mg daily in veterans with PTSD and with no side effects (Raskind 2009, personal communication). Prazosin Prazosin is an α1 adrenoreceptor antagonist; it is nonsedating and blocks excessive responsiveness to norepinephrine stimulation at postsynaptic α1 adrenergic receptor. Following oral administration, human plasma concentrations reach a peak at about 3 h with a plasma half life of 2–3 h. The drug is highly bound to plasma protein.