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?


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.

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