(132) Less of a Nightmare? A Case Report Comparing Doxazosin and Prazosin for PTSD in the Consultation-Liaison Setting

Abstract:

Introduction: Doxazosin and prazosin are α1-antagonists that have evidence for the treatment of trauma-related nightmares.1,2,3 To our knowledge, there are no reports of doxazosin use in the general hospital setting. One significant advantage of using doxazosin over prazosin in the medically ill is its relatively lower propensity to affect blood pressure.4 We describe the case of a patient on our consultation-liaison (C-L) service who, due to supply limitations, received doxazosin in place of prazosin for post traumatic stress disorder (PTSD)-related nightmares. The patient was previously started on prazosin in the same setting, allowing for the first known comparison of these medications in the C-L setting.




Case: M.M. is a 43-year-old female with a history of pancreatitis, alcohol use disorder (AUD), and PTSD. C-L was consulted four times in the last year for AUD, and started her on prazosin for nightmares. During these admissions, she received up to 2 mg of prazosin for nightmares. During her recent medical hospitalization, prazosin was not available in our pharmacy, and the patient alternatively received doxazosin 4 mg. She reported no difference in symptoms or tolerability on doxazosin 4 mg as compared to prazosin 2 mg. Her blood pressure remained stable on both medications.




Discussion: Previous case reports and reviews demonstrate the efficacy of doxazosin for PTSD-related nightmares in a clinic population.1,2, Our findings suggest that doxazosin is an efficacious and tolerable alternative to prazosin for patients suffering from post-traumatic nightmares in the C-L setting. In addition to potential supply chain issues that may impact prazosin availability, doxazosin has several inherent properties which may render it preferable to prazosin for the C-L population. These include a longer half life, lesser blood pressure effects, and therapeutic indications for AUD, benign prostatic hypertrophy, and urinary retention.4




Conclusion: Limited data exists on the use of prazosin and doxazosin in the C-L setting, and on the use of doxazosin for nightmares in any setting. Further clinical research is indicated, as these medications, doxazosin especially, may be underutilized treatment options for C-L patients who may be at increased risk of experiencing trauma-related nightmares.



Citations:

1. Sethi R et al. Doxazosin for the treatment of nightmares: does it really work? A case report. Prim Care Companion CNS Disord. 2012;14(5):PCC.12l01356.

2. Pallesen S et al. Doxazosin for the treatment of nightmare disorder: A diary-based case study. SAGE Open Med Case Rep. 2020;8:2050313X20936079.

3. Calegaro VC et al. Treating nightmares in PTSD with doxazosin: a report of three cases. Braz J Psychiatry. 2019;41(2):189-190.

4. Smith C, et al. Evidence for Using Doxazosin in the Treatment of Posttraumatic Stress Disorder. Psychiatr Ann. 2016;46(9):553-555.