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A very rare side effect of prazosin is priapism. [3] [21] One phenomenon associated with prazosin is known as the "first-dose response", in which the side effects of the drug — specifically orthostatic hypotension, dizziness, and drowsiness — are especially pronounced in the first dose. [3]
Prazosin (Minipress) for nightmares: prazosin is approved for the use of hypertension. A 2012 systematic review showed a small benefit for the treatment of PTSD-associated night terrors. Other non-FDA-approved uses for prazosin include the treatment of Raynaud's disease and poisoning due to scorpion venom.
High doses of the α 1 blocker, prazosin, have been efficacious in treating patients with PTSD induced nightmares due to its ability to block the effects of norepinephrine. [27] Adverse effects of prazosin to treat PTSD nightmares include dizziness, first dose effect (a sudden loss of consciousness), weakness, nausea, and fatigue. [27]
Prazosin (alpha-1 blocker) appears useful in decreasing the number of nightmares and the distress caused by them in people with PTSD. [28] [29] Risperidone (atypical antipsychotic) at a dosage of 2 mg per day, has been shown in a case report to lead to the remission of nightmares on the first night. [29]
The risk of first dose phenomenon may be reduced or eliminated by gradual-dose titration, since the adverse effects of Prazosin are dose-related. [7] This is also the case for Tamsulosin and it may be assumed that the others alpha-1 blockers work in a similar manner, since Tamsulosin is an alpha-1-a blocker and Prazosin is an alpha-1 blocker. [30]
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This postural hypotension usually happens shortly after the first dose is absorbed into the blood and can result in syncope (fainting). Syncope occurs in approximately 1% of patients given an initial dose of 2 mg prazosin or greater. This adverse effect is self-limiting and in most cases does not recur after the initial period of therapy or ...
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