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Raskind MA, et al. Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans. N Engl J Med. 2018;378(6):507-517. PMID 29414272

One-paragraph summary

A 13-centre VA trial randomized 304 veterans with chronic PTSD and frequent nightmares to prazosin or placebo for 26 weeks, with escalation to maximum daily doses of 20 mg in men and 12 mg in women.

Key findings

  • Week-10 nightmare-item difference: 0.2 (95% CI −0.3 to 0.8; p=.38).
  • Week-10 PSQI difference: 0.1 (95% CI −0.9 to 1.1; p=.80).
  • CGIC difference: 0 (95% CI −0.3 to 0.3; p=.96); primary outcomes also showed no difference at week 26.
  • Supine systolic blood pressure decreased 6.7 mm Hg more with prazosin.

Limitations

  • The sample was predominantly veteran and required frequent nightmares; transportability is bounded.
  • A null average effect does not identify whether a prospectively definable subgroup benefits.
  • The result conflicts with smaller earlier positive trials and should be displayed alongside them, not averaged away.

Why it matters

This record changed the evidentiary baseline for large prazosin re-test; later claims should begin from this result rather than earlier narrative consensus.

Cited by wiki pages

  • sleep-and-nightmare-treatment
  • pharmacotherapy
  • military-and-veteran-populations