Prazosin Market Status
No, prazosin is NOT withdrawn from the market and remains widely available for clinical use. The medication continues to be prescribed for hypertension, benign prostatic hyperplasia, and PTSD-associated nightmares 1, 2.
Current Clinical Applications
Prazosin remains an active therapeutic option with multiple FDA-approved and off-label indications:
Hypertension and benign prostatic hyperplasia: The American College of Cardiology continues to recommend prazosin for these conditions due to its selective alpha-1 blockade mechanism 2.
PTSD-associated nightmares: The American Academy of Sleep Medicine recognizes prazosin as a first-choice pharmacologic therapy for nightmare disorder, despite recent contradictory evidence requiring a downgraded recommendation 1.
Active prescribing: Multiple clinical studies from 2014 through 2018 describe ongoing prazosin use, with dosing protocols ranging from 1 mg to 45 mg daily depending on indication 3, 4, 1.
Why the Confusion May Exist
You may be confusing prazosin with drotrecogin alfa (activated), which was actually withdrawn from the market 1. Drotrecogin, a recombinant form of activated protein C used for severe sepsis, was removed after two clinical trials showed lack of efficacy and potential harm from bleeding 1.
Important Safety Considerations
The American Academy of Sleep Medicine and other guideline societies emphasize critical safety measures when prescribing prazosin 2, 5:
First-dose phenomenon: Significant orthostatic hypotension can occur, particularly after initial dosing 2.
Dosing strategy: Start at 1 mg at bedtime with gradual titration to minimize orthostatic effects, especially in elderly patients or those on concurrent antihypertensives 2, 6.
Adverse effects requiring discontinuation: Sleep paralysis represents an intolerable side effect necessitating immediate discontinuation 5.