From the Guidelines
Prazosin should be started at a low dose of 1 mg at bedtime and gradually increased by 1 mg every few days as tolerated, with a target dose ranging from 3-15 mg at bedtime for effective symptom control of nightmares. The dose of prazosin can be adjusted based on individual patient response and tolerance, with the goal of minimizing side effects such as dizziness and hypotension 1. Key considerations when prescribing prazosin for nightmares include:
- Starting with a low dose to minimize side effects
- Gradually increasing the dose as tolerated
- Monitoring for potential side effects, including hypotension
- Optimizing the timing of medication administration, such as taking it 1-2 hours before bedtime on an empty stomach
- Being patient and consistent with treatment, as it may take several weeks to achieve full therapeutic effect 1. It's also important to note that prazosin may interact with other medications, such as antidepressants, which could impact its effectiveness 1. Overall, prazosin remains a first-line treatment option for nightmares associated with PTSD and other conditions, despite some contradictory study results, due to its efficacy and relatively favorable side effect profile 1.
From the Research
Recommended Dose of Prazosin for Nightmares
The recommended dose of prazosin for nightmares varies across studies.
- The initial dose is typically 1 mg, with titration upward until the desired reduction of nightmares is achieved 2, 3, 4.
- The maximum recommended dosage is 20 mg at bedtime and 5 mg midmorning 2.
- Other studies suggest maintenance levels of 2-6 mg at night, with higher doses (e.g., 10-16 mg at night) used in military patients with PTSD 3.
- A therapeutic benefit has been reported with prazosin dosages as low as 1 mg daily, with suppression of nightmare symptoms occurring within one week of prazosin initiation 4.
- The prazosin dose has ranged from 1 to 16 mg/d in various studies 5.
Considerations for Dosing
When initiating prazosin, it is essential to monitor for hypotension after the first dose 3.
- Prazosin has been shown to be effective in reducing nightmares in patients with both combat- and noncombat-related trauma 4.
- The use of prazosin for nightmares has been explored in various populations, including patients with PTSD, serious illness, and those who do not meet diagnostic criteria for PTSD 6.