A retrospective chart review to determine the safety and efficacy of prazosin for nightmares related to posttraumatic stress disorder in veterans.

Objective: To evaluate the efficacy of prazosin for posttraumatic stress disorder (PTSD)-related nightmares in veterans and to analyze subgroup benefit/risk to guide prescribing.

Methods: Patients with a previous prescription for prazosin between 1 June 2007 and 30 June 2017 were collected from the institution's electronic records. Efficacy (including nightmare frequency, and clinical PTSD rating scales) and safety (including blood pressure) data were retrospectively analyzed.

Results: Eighty-four patients were included in the analysis. The primary outcome, item 2 of the PTSD checklist, decreased from 4.00 to 3.19 (on a scale of 1-5), which was statistically significant (p < 0.05). Nightmare frequency was found to have a statistically significant decrease from four to two times per week on average (p = 0.00002, 95% CI 2.36 [1.39-3.33]). Of the patients who reported the greatest response (n = 23), 91% (n = 21) were on an antidepressant and 61% (n = 14) were receiving concurrent psychotherapy. This is compared to 90% (n = 76) and 44% (n = 37) of the total cohort, respectively. No significant differences were found in blood pressure or suicidal ideation (p = 0.58 and p = 0.22, respectively).

Conclusion: Prazosin may be considered as an adjunct option to decrease nightmare frequency in patients already receiving first-line treatment.