Waking up frequently throughout the night makes it difficult to enter REM sleep or achieve the deep, restorative sleep your brain and body need. Many people with PTSD report less trouble falling asleep and more trouble staying asleep. Studies show that Prazosin may help reduce anxiety and the frequency of these flashbacks and nightmares, helping patients feel more relaxed and able to fall and stay asleep. Following a traumatic or life-threatening event, some people develop a severe anxiety disorder that involves flashbacks of the event and panic attacks, which affects their ability to achieve quality sleep. 5 The symptoms described in the earlier case report 5 and the present case are summarized and compared in Table 1.Prazosin is sometimes used to treat other conditions including congestive heart failure, adrenal gland tumors, an enlarged prostate (not associated with cancer), Raynaud’s disease), and sleep issues associated with PTSD (post-traumatic stress disorder). 3 Prazosin has only been reported in a single case report as being associated with bizarre behavior and dissociative symptoms in a patient with PTSD. Insomnia and hallucination are listed as some of the rare side effects of prazosin by the manufacturer. There is growing evidence in the off-label use of prazosin as the most promising pharmacological agent in treating nightmares associated with PTSD 2 however, the literature about the psychiatric adverse effects of prazosin is very limited. 1 Thus, the modulation of the noradrenergic system is suggested to be an effective strategy in treating sleep disturbances associated with PTSD. 4 The noradrenergic system is thought to have the leading role in fear memory formation, consolidation and especially recalling which is associated with sleep disturbances and nightmares observed in PTSD. Excessive noradrenergic activity in the central nervous system is associated with sleep disturbance, a characteristic of PTSD. Prazosin selectively antagonizes α1-adrenergic receptors in the brain. In these studies, military-veterans, soldiers on duty and civilians with PTSD nightmares were treated successfully with prazosin dose ranging between 6 mg to 25 mg per day. 1 demonstrated that prazosin was significantly more efficacious than placebo in reducing nightmares in PTSD patients. A recent systematic review and meta-analysis by Berardis et al. Prazosin is a non-sedating α1-adrenergic antagonist, used in the treatment of hypertension and BPH. This is the first case, to our knowledge, reporting nightmares caused by prazosin in a patient without mental illness. Four days after the changeover the patient found a significant improvement, and 7 days after, his nightmares disappeared and his quality of sleep slowly restored. The patient was referred to a urologist and prazosin was replaced with dutasteride 500 mcg, and tamsulosin HCl 400 mcg. The patient re-commenced prazosin, and nightmares returned after a few days. The patient stopped taking his simvastatin, aspirin and prazosin, sequentially, over 3 days as a trial and found that once he stopped taking prazosin for a few days, the frequency of nightmares reduced however, the patient was not comfortable to discuss this with his medical practitioner for fear of disappointing him. The nightmares caused severe sleep disturbances resulting in psychological stress. The patient has been taking prazosin 1 mg daily at night for the past 1.5 years for BPH with good effect he reported that the nightmares had commenced soon after prazosin was started and had become more frequent. He was being treated with prazosin 1 mg, aspirin 100 mg, simvastatin 40 mg, calcium 600 mg and vitamin D 1000IU daily. The patient had a history of benign prostate hypertrophy (BPH), hypercholesterolemia, generalized osteoarthritis, and pre-diabetes. A 78-year-old Caucasian man with no previous history of mental illness was referred to a pharmacist for a medication review.
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