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Pharmacological Treatment of Nightmares, Sleep Disturbance, and Daytime Hyperarousal in PTSD: The Role of Prazosin, Other Noradrenergic Modulators, and Sedative Hypnotics or Commonly Used Sedating Medications 

Pharmacological Treatment of Nightmares, Sleep Disturbance, and Daytime Hyperarousal in PTSD: The Role of Prazosin, Other Noradrenergic Modulators, and Sedative Hypnotics or Commonly Used Sedating Medications
Chapter:
Pharmacological Treatment of Nightmares, Sleep Disturbance, and Daytime Hyperarousal in PTSD: The Role of Prazosin, Other Noradrenergic Modulators, and Sedative Hypnotics or Commonly Used Sedating Medications
Source:
Post-Traumatic Stress Disorder
Author(s):

Rebecca C. Hendrickson

, and Murray A. Raskind

DOI:
10.1093/med/9780190259440.003.0035

Disruption of stress-response systems contributes to the pathophysiology of post-traumatic stress disorder (PTSD). Consistent with this, daytime hyperarousal and nighttime sleep disruption, including trauma-related nightmares, are core symptoms of the disorder, often requiring targeted pharmacologic treatment. Although a variety of medications that target sleep–wake and arousal mechanisms are commonly used for this purpose, there remains the best empirical support for prazosin, a brain-active antagonist of the α‎1 noradrenaline receptor, with emerging evidence for doxazosin, a longer-acting medication with the same mechanism of action. This chapter reviews the evidence for use of prazosin and doxazosin as well as for the sedative hypnotics (benzodiazepines, nonbenzodiazepine hypnotics, and related medications), antihistamines, and sedating antidepressants trazodone and nefazodone to address hyperarousal symptoms and trauma-associated nightmares in PTSD. Clinical recommendations for the use of prazosin in PTSD, as well as a discussion of emerging pharmacologic treatments, are also included.

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