Minipress (Prazosin) for Stress Nightmares in PTSD

How Common Is PTSD?

Historically, only veterans coming home from combat were diagnosed with post-traumatic stress disorder (PTSD). Now, clinicians recognize patients who experience other types of traumatic events can also suffer from this debilitating mental condition.

Women are more than twice as likely as men to develop PTSD after experiencing or witnessing a traumatic event. Aside from the triggering event, a diagnosis of PTSD requires symptoms in each of five categories:

• Re-experiencing the event through unwanted memories, nightmares, flashbacks, or strong reactions to reminders of the event
• Avoiding reminders of the trauma, including people, places, and objects
• Negative changes in your mood and thoughts associated with the triggering event
• Chronic hyperarousal symptoms, which may include irritability, aggression, risk-taking, or hypervigilance
• Symptoms lasting longer than one month, creating functional impairment, and not caused by medication or substance abuse

How Prazosin Works to Treat Nightmares

Prazosin blocks responsiveness to norepinephrine, a stress hormone that affects your brain, at specialized chemical receptors called alpha-1 receptors. It is not clear how this specifically impacts sleep or dreams.

Other Therapeutic Uses

Clinical studies show prazosin may offer other therapeutic benefits to PTSD patients, but the results are mixed. One study suggested that taking prazosin:

• Significantly reduced daytime PTSD symptoms in patients already taking it at night
• May have a beneficial effect on alcohol cravings for participants who were alcohol dependent and trying to stop drinking. This is important when considering the number of PTSD patients who turn to alcohol for comfort and end up with an alcohol use disorder

Who Should Not Use Prazosin

If you have previously had adverse reactions to this or similar medications, don’t take prazosin. Prazosin isn’t usually prescribed to those over age 65. People in the following groups should use prazosin with caution, be sure to tell your healthcare provider if any of the following apply to you:

• Low blood pressure
• Narcolepsy
• A history of liver disease or prostate cancer
• If you’re pregnant or could become pregnant
• If you’re breastfeeding
• If you’re going to have any surgery, including cataract surgery or dental surgery

Common Side Effects

Prazosin can cause side effects. In clinical trials, these included:

• Drowsiness in 7.6% of patients
• Lack of energy in 6.9% of patients
• Weakness in 6.5% of patients
• Dizziness in 10.3% of patients

Safety Precautions

As described above, certain people should use prazosin with caution or not at all. The safety of its use while pregnant or breastfeeding is not known, so these populations should use caution. It may also be important to monitor your blood pressure with prazosin use to ensure it does not become too low and cause fainting or falls.

A Word From Verywell

If you experience any difficulties, you should be in close contact with your primary healthcare provider. PTSD is a serious condition and it deserves treatment. Don’t suffer in silence: reach out to get the help that you need to sleep more normally. If you suffer from depression or experience thoughts of suicide, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.