Question: In people with PTSD (including single and multiple event trauma) how effective is prazosin compared with either no treatment, psychological therapy alone, or a combination of prazosin and psychotherapy, in reducing trauma related nightmares. What information is there around the duration of treatment required, and the return of nightmares upon cessation?

Answer:

Four smallUSbased studies conducted mainly in male military veterans suggest that prazosin is an effective and well-tolerated treatment in reducing trauma related nightmares.  One RCT suggested that a behavioural sleep intervention had similar effectiveness to prazosin. Very limited evidence from single studies suggests that the treatment effect is seen after 3 weeks of treatment (the earliest time point after treatment initiation for which data were available) and is greater after 8 weeks of treatment. Nightmares appear to return immediately upon treatment cessation although this was based on data from one very small (n=10) cross-over trial and so should be interpreted with caution.  There is a need for larger studies conducted in a broader range of participants; the only study not conducted in military personnel included only 13 participants.