Based on this work, the alpha-1 receptor antagonist, prazosin, and the alpha-2A agonist, guanfacine, are

now being tested and used to treat PTSD. The following reviews this emerging clinical research. The alpha-1 adrenoceptor blocker, prazosin, proved a logical Rapamycin price choice for human experimentation because of its clinical availability and it being the most lipid soluble of the alpha-1 antagonists, facilitating CNS penetration following oral administration. Prazosin trials in PTSD were initiated in both military and civilian cohorts in parallel, in part based on the research in animals described above. The military studies will be addressed first. Four combat-related PTSD prazosin efficacy studies have been completed and published, all randomized controlled trials (RCTs), all demonstrating significant and substantial efficacy of prazosin for reducing nighttime PTSD symptoms,

reducing daytime hyperarousal symptoms and improving global clinical status. It is noteworthy that the hyperarousal scale includes many PFC-related symptoms (e.g. impaired concentration, impaired regulation of mood and aggression), in addition to alterations in sleep-wakefulness. The first three trials focused on prazosin RG7204 for the treatment of nightmares and only administered prazosin at night; the fourth study including a morning dose to extend observations more meaningfully into daytime experience. The participants in the first two RCTs were Vietnam War combat veterans with decades of treatment resistant chronic PTSD. Prazosin was administered as a single evening dose specifically to target persistent and distressing trauma-related nightmares and sleep disruption as primary outcome measures. The Clinical Global Impression of Change (CGIC) also was assessed to determine the impact of nightmare reduction Rutecarpine and sleep improvement in global clinical status anchored to function at home and work. The first RCT was a double-blind placebo-controlled crossover study performed in 10 veterans (Raskind et al., 2003). Prazosin or placebo in

random order were begun at an initial dose of 1 mg at bedtime and titrated upward for 3 weeks to a dose that eliminated trauma nightmares or to a maximum dose of 10 mg HS. The achieved maintenance dose was maintained for 6 weeks. Following a one-week washout period, participants were crossed over to the other treatment condition, again for 3 weeks titration and 6 weeks maintenance. At a mean achieved maintenance prazosin dose of 9.6 mg, prazosin was significantly and substantially superior to placebo for reducing nightmares (CAPS “recurrent distressing dreams of the event” item) and sleep disturbance (CAPS “sleep difficulty” item) and improving global clinical status. Change in total CAPS score and all three CAPS PTSD symptom clusters (reexperiencing, avoidance and hyperarousal) also significantly favored prazosin. The second RCT was a parallel group study on forty veterans randomized to prazosin or placebo (Raskind et al.