title: Doxazosin XL reduces symptoms of posttraumatic stress disorder in veterans with PTSD: a pilot clinical trial.
abstract: BACKGROUND
  Serotonin and norepinephrine reuptake inhibitors are effective first-line agents for the treatment of posttraumatic stress disorder (PTSD), but treatment is associated with a range of side effects that limit treatment adherence. Prazosin, an α1-noradrenergic antagonist with a half-life of roughly 2-3 hours, has shown promise in the treatment of sleep disturbance and nightmares. Doxazosin extended release (XL) is also an α1-noradrenergic antagonist but with a half-life of approximately 15-19 hours.
  
  
  METHODS
  We conducted a double-blind, placebo-controlled, within-subjects trial to characterize the impact of doxazosin XL on PTSD symptoms. Participants (N = 8) were diagnosed using DSM-IV criteria. They completed the study twice, once during treatment with doxazosin XL and once during treatment with matched placebo, with a 2-week washout separating the 2 episodes. Doxazosin XL was titrated from 4 mg/d to 16 mg/d over 12 days. After 4 days of treatment at 16 mg/d or the equivalent number of placebo capsules, PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS17) and the PTSD Checklist-Military version (PCL-M). Repeated measures analysis of variance were used to evaluate effects of treatment, time, and treatment × time. This study was run from November 20, 2013, to June 31, 2014.
  
  
  RESULTS
  Doxazosin XL treatment was associated with a nonsignificant treatment × time reduction in ratings on the CAPS hyperarousal subscale (P < .10) (but not on the CAPS Total score) and with significant treatment × time reductions in PCL-M ratings (P = .002).
  
  
  CONCLUSIONS
  Doxazosin XL may be an effective alternative to prazosin for the treatment of some PTSD symptoms.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier:NCT02308202.
authors.affiliation: Michael E. DeBakey, Virginia Medical Center, Houston, Texas.|Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rodgman
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Verrico
authors.forename: Manuela
authors.initials: M
authors.lastname: Holst
authors.forename: Daisy
authors.initials: D
authors.lastname: Thompson-Lake
authors.forename: Colin N
authors.initials: CN
authors.lastname: Haile
authors.forename: Richard
authors.initials: R
authors.lastname: De La Garza
authors.forename: Murray A
authors.initials: MA
authors.lastname: Raskind
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Newton
mesh_terms: D000328:Adult; D002648:Child; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D017292:Doxazosin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010865:Pilot Projects; D013313:Stress Disorders, Post-Traumatic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*
chemical_list: D003692:Delayed-Action Preparations; D017292:Doxazosin