Post-traumatic stress disorder (PTSD) can occur following a traumatic event. Nightmares are a common symptom of PTSD, which may cause a person to ​​replay the traumatic event from their past. One possible medical treatment for PTSD nightmares is the drug prazosin.

According to the National Alliance on Mental Illness (NAMI), PTSD affects 3.6% of the adult population in the United States. This is around 9 million people.

NAMI also states that around 37% of those with PTSD have severe symptoms.

This article discusses PTSD nightmares and the drug prazosin. It outlines how prazosin works, its side effects, other PTSD medications, and other PTSD treatments.

A man sitting on his bed thinking about the best medication for PTSD nightmares.Share on Pinterest
Helén Lindelöf/EyeEm/Getty Images

PTSD is a disorder that can affect a person if they have experienced or witnessed a traumatic event.

Long-term effects of PTSD include:

Sleep issues can be some of the most challenging aspects of having PTSD. Common sleep difficulties include insomnia and nightmares.

People with PTSD may have intense nightmares that occur regularly. These nightmares may include replays of the traumatic event or events that caused the person to develop PTSD.

Learn more

Find out more about PTSD.

Prazosin is a medication that comes in the form of an oral capsule. One brand name for the drug is Minipress. People can also purchase the generic version of the drug.

Doctors usually prescribe prazosin to treat high blood pressure as it widens the blood vessels, allowing the blood to flow more easily.

However, doctors also prescribe prazosin off-label to treat PTSD-associated nightmares. This means that the Food and Drug Administration (FDA) has not approved it for this purpose, but it may still help reduce PTSD nightmares.

Prazosin has an affect on alpha-1 receptors that are present on smooth muscle tissue, including the blood vessel walls and the brain. This results in the relaxation of these smooth muscles, leading to a decrease in blood pressure.

It is also able to cross the blood-brain barrier, which may help treat PTSD-associated nightmares.

Studies have shown that the medication can be an effective treatment in reducing the amount of PTSD nightmares a person has.

However, the evidence is mixed. One 2018 clinical trial included a number of military veterans with PTSD. The trial concluded that prazosin did not alleviate distressing dreams or improve sleep quality.

More research is needed to determine whether prazosin is an effective treatment for PTSD nightmares.

Prazosin has several potential side effects.

The most common of these affect between 5–10% of people, and include:

More serious but less common side effects include hypotension, or low blood pressure. First-dose hypotension can be serious, so doctors recommend that a person takes their initial dose at night.

People may also develop orthostatic hypotension, which is a form of hypotension that occurs when a person stands up after sitting or lying down.

A person taking prazosin may also develop syncope, which is another name for fainting. This is a temporary loss of consciousness that may be related to a lack of blood flow to the brain.

Other less common side effects, which affect between 1–4% of people, include:

There are also some very rare side effects. These affect less than 1% of people that take the drug and include:

If a person takes prazosin and experiences any severe side effects, including fainting, weakness, tachycardia, impotence, or orthostatic hypotension, they should consider alternative treatments.

If a person is taking other medications, they should always check with a doctor before taking prazosin. This is because it may interact with other medications.

One of the possible side effects of prazosin is low blood pressure. This may make a doctor less likely to prescribe prazosin to someone already taking medications that lower their blood pressure. This is to prevent their blood pressure from decreasing further.

There is no one medication that a person can use to treat all of their PTSD symptoms. Some medications can help with certain symptoms and may also increase the effectiveness of psychotherapy. However, they may not specifically treat PTSD nightmares.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are two types of antidepressant medications.

Below are four of the more common SSRIs and SNRIs that doctors may prescribe to treat PTSD:

However, the only FDA-approved antidepressants for PTSD are sertraline and paroxetine.

These medications work by balancing certain hormones and chemicals in the brain to reduce certain symptoms of PTSD.

Learn the differences between SSRIs and SNRIs.

There are several other nonmedical treatments that a person may wish to consider to help them manage their nightmares.

Imagery rehearsal therapy (IRT)

Imagery rehearsal therapy (IRT) is a possible treatment for PTSD nightmares. IRT is a form of cognitive behavioral therapy (CBT).

During IRT, a therapist will provide the individual with background information about sleep and nightmares. This can help a person manage their nightmares.

The individual then works closely with their therapist to create their own nonfrightening endings for the nightmares they experience. They can write down these endings and rehearse them mentally.

IRT also helps a person learn how to monitor their nightmares in order to understand how effective the therapy is.

Studies show that IRT is a powerful strategy for treating PTSD nightmares.

A 2015 meta-analysis looked at the short-term effects of prazosin compared to IRT on nightmares, sleep quality, and PTSD symptoms. It revealed that both prazosin and IRT showed comparable and moderate effects on PTSD nightmares and other symptoms.

Cognitive behavioral therapy (CBT)

CBT is a type of talk therapy that focuses on the way people think and interpret events in their life.

During a CBT session, a therapist will work with a patient to explore and develop methods to deal with certain challenges and behaviors.

Studies show that CBT can be an effective treatment for helping manage PTSD symptoms, including sleep disturbances.

One 2015 review of a number of studies concluded that sleep-specific CBT was an effective treatment for PTSD symptoms, such as sleep disturbances.

Studies also show that CBT combined with IRT can improve treatment outcomes leading to better sleep quality in people with PTSD.

There are several other things that a person may wish to do to help manage their PTSD nightmares.

Some of the following measures may help a person reduce the frequency or intensity of PTSD nightmares:

  • Talking: Regularly discussing the nightmares with a friend, family member, or therapist may help alleviate some of the anxiety associated with them. It may help a person process the emotions and memories that the nightmares bring up.
  • Keeping a dream diary: Keeping track of dreams and writing them out on a page may help a person process them and achieve some distance from the nightmares.
  • Relaxing before bed: Setting aside time to get comfortable and alleviate any stress may reduce the chances of having a bad dream. Taking a relaxing bath or meditating before bed may help.
  • Avoiding screens before bed: Watching TV or scrolling on a mobile phone stimulates the brain, which may make it more difficult to unwind before bed.

One possible medication for PTSD nightmares is the drug prazosin. Doctors normally prescribe it for high blood pressure, but they may prescribe it off-label to reduce PTSD nightmares.

However, some side effects of prazosin include dizziness, headaches, drowsiness, weakness, heart palpitations, and nausea.

Other effective treatments for PTSD nightmares include CBT and IRT.

A person may also wish to discuss their nightmares with someone they trust, or keep a dream diary to help them cope.