Terazosin for PTSD?

[Chrismander]

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There's some evidence for prazosin in the treatment of nighttime PTSD sx. has anyone heard of using terazosin for the same purpose? One of my VA PTSD patients is on it already for BPH so I don't know whether he'd be getting any anti-PTSD effect from it or not. The mechanism of action is the same and the molecules are pretty close to identical, but who knows. Anyone see terazosin used in this way? What were the results?

 

[whopper]

From Pubmed..
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The non-antidepressant agent with the strongest scientific evidence supporting its use in PTSD is risperidone, which can be envisaged as an effective add-on therapy when patients did not fully benefit from previous treatment with SSRIs. Prazosin, an adrenergic-inhibiting agent, is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms. So far, there is no consistent empirical support for using benzodiazepines in the prevention or in the treatment of PTSD, although these drugs could alleviate some associated non-specific symptoms, such as insomnia or anxiety. Further controlled clinical trials and meta-analysis are needed to guide clinicians in their search of effective pharmacological alternatives to antidepressants in PTSD.

I have heard Prazosin having some PTSD benefit, though I never saw any data in studies until I did the pubmed search.

I haven't seen Terazosin used, though your logic is sound. I would though put the person on an SSRI anyway, and consider the use of prazosin or terazosin only after other therapies have been attempted.

 

[sunlioness]

I agree with Whopper. SSRIs are first line for PTSD. That and regular psychotherapy (which is actually most important). I am familar with the data on prazosin, but in my own practice I haven't been too impressed with it. The guy I worked with at the VA PTSD clinic when I was a resident wasn't too impressed with it either. Risperdal or Seroquel seemed to work better for sleep/nightmares.

 

[masterofmonkeys]

i have used prazosin on occasion and was stunned by its effect on nightmares and insomnia. Not much help on daytime aspects though.

 

[michaelrack]

I used on of them- can't remember if it was terazosin or prazosin- late last year on a pt with ptsd/insomnia/combat-related nightmares. He was already seen at the va and was on a ssri. He self-referred himself to me for insomnia. He did have some improvement on the alpha-1 blocker.

I would recommend keeping the dose at less than 6 mg for either one due to hypotension/orthostatic hypotension.

 

[PsychSouth]

I have used terazosin a good bit for PTSD nightmares with good results. It has a longer half-life than prazosin, potentially making it a better choice.

However, one of my attendings have mentioned that he didn't think terazosin crossed the blood brain barrier as readily, making it less effective for PTSD sx's.