The Off-Label Use of Prazosin for Sleep Disturbances in Noncombat Posttraumatic Stress Disorder

Background: Posttraumatic stress disorder (PTSD) is a form of anxiety disorder that arises after exposure to a traumatic event or stressor. It is characterized by persistent invasive thoughts, emotional detachment, hypervigilance and sleep disturbances. These sleep disturbances include nightmares, insomnia and distressed awakenings and are often refractory to multiple medications, including SSRIs, which are the only FDA approved medication for PTSD. Prazosin is an alpha-1 adrenergic antagonist that has been studied for use in nighttime symptoms of PTSD in civilian populations, however most data exists for its use in combat-related PTSD. This review examines the differences in these two populations and investigates the off-label use of prazosin for sleep disturbances in noncombat posttraumatic stress disorder. Methods: Exhaustive search of available medical literature via MEDLINE, CINAHL, PILOTS, and PsychINFO databases using combinations of the terms PTSD, Stress Disorder, Prazosin, Alpha Antagonist and Alpha Blocker. Inclusion criteria were set to incorporate studies that used prazosin to treat nighttime symptoms of PTSD in a noncombat, non-military population. Exclusion criteria eliminated studies pertaining to combat PTSD, military or veteran population. Non peer-reviewed Letters to Editor were also excluded. Results: Four studies, including one randomized control trial, one retrospective cohort, one case series and one case study were found. Conclusion: Prazosin has potential as a treatment for the sleep disturbances of noncombat related PTSD. Both the prevalent female gender and heterogeneity of individual traumas in this civilian population were much different than previous trials and reviews that examined combat PTSD. While the demographics and experiences were diverse compared to the veteran population, the positive response to prazosin was similar to past findings. While larger, randomized and placebo-controlled trials are needed for FDA approval, the current off-label use of prazosin is demonstrated in the existing literature as efficacious. Degree Type Capstone Project Rights Terms of use for work posted in CommonKnowledge. This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/211 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license. ] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:. copyright@pacificu.edu This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/211 NOTICE TO READERS This work is not a peer-reviewed publication. The Master’s Candidate author of this work has made every effort to provide accurate information and to rely on authoritative sources in the completion of this work. However, neither the author nor the faculty advisor(s) warrants the completeness, accuracy or usefulness of the information provided in this work. This work should not be considered authoritative or comprehensive in and of itself and the author and advisor(s) disclaim all responsibility for the results obtained from use of the information contained in this work. Knowledge and practice change constantly, and readers are advised to confirm the information found in this work with other more current and/or comprehensive sources. The student author attests that this work is completely his/her original authorship and that no material in this work has been plagiarized, fabricated or incorrectly attributed. The Off-Label Use of Prazosin for Sleep Disturbances in Noncombat Posttraumatic Stress Disorder