Clinical case series: the use of Prazosin for combat-related recurrent nightmares among Operation Iraqi Freedom combat veterans.
OBJECTIVE
Increased central nervous system norepinephrine outflow and alpha1-adrenergic receptor responsiveness appear to be involved in the pathophysiologic processes of trauma-related nightmares in post-traumatic stress disorder. On the basis of reports that the brain-accessible alpha1-adrenergic antagonist Prazosin substantially reduced chronic combat-related nightmares among Vietnam War veterans, we evaluated Prazosin effects on combat-related nightmares among combat soldiers returning from Operation Iraqi Freedom.


METHODS
Twenty-eight soldiers who self-reported distressing combat trauma-related nightmares on a postdeployment questionnaire were prescribed low-dose Prazosin before bedtime.


RESULTS
Of the 23 soldiers for whom follow-up evaluations were available, 20 experienced marked improvement (complete elimination of nightmares), 2 experienced moderate improvement (reduced nightmare frequency or intensity), and 1 experienced no change. Prazosin was well tolerated.


CONCLUSIONS
Prazosin appeared highly beneficial for combat-related nightmares characteristic of post-traumatic stress disorder among troops recently returned from Operation Iraqi Freedom. These findings provide a rationale for a placebo-controlled trial to establish efficacy in this population.
Department of Psychiatry, Madigan Army Medical Center, Tacoma, WA 98431, USA.
Christine Maura
CM
Daly
Michael E
ME
Doyle
Murray
M
Radkind
Elaine
E
Raskind
Colin
C
Daniels
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D003130:Combat Disorders / Q000188:drug therapy*; D004325:Dreams / Q000523:psychology*; D005260:Female; D006801:Humans; D007493:Iraq; D008297:Male; D011224:Prazosin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014728:Veterans; D014857:Warfare
D000317:Adrenergic alpha-Antagonists; D011224:Prazosin