Efficacy Of Prazosin Research Articles

Study on Clinical Profile and Efficacy of Prazosin in Scorpion Sting Envenomation in Children of Anathapur

Study on Clinical Profile and Efficacy of Prazosin in Scorpion Sting Envenomation in Children of Anathapur

Moderation of Prazosin's Efficacy by Alcohol Withdrawal Symptoms.

Alcohol use disorder (AUD) is a leading cause of global disease burden. Chronic, heavy use increases the likelihood of alcohol withdrawal symptoms and associated secondary outcomes of alcohol craving and mood, anxiety, and sleep disturbances, which are predictive of poor treatment outcomes. The authors examined whether alcohol withdrawal symptoms moderate the efficacy of prazosin in reducing alcohol intake and associated secondary outcomes. A 12-week, double-blind, randomized, controlled proof-of-concept trial of prazosin (16 mg/day, with a 2-week titration) was conducted in community-recruited adults with current alcohol dependence (N=100) with varying levels of alcohol withdrawal symptoms assessed at treatment entry. Primary outcomes were daily self-reported drinking days and heavy drinking days, and secondary outcomes were average drinks/day and mood, anxiety, craving, and sleep quality ratings. Modified intent-to-treat analyses indicated a significant interaction of alcohol withdrawal symptom score by treatment by full-dose treatment period (weeks 3-12) for drinking days, heavy drinking days, and average drinks/day. By week 12, participants with high alcohol withdrawal symptoms on prazosin reported 7.07% heavy drinking days and 27.46% drinking days, while those on placebo had 35.58% heavy drinking days and 58.47% drinking days (heavy drinking days: odds ratio=0.14, 95% CI=0.058, 0.333; drinking days: odds ratio=0.265, 95% CI=0.146, 0.481). No such benefit of prazosin was observed in those reporting low or no alcohol withdrawal symptoms. Individuals with high alcohol withdrawal symptoms on prazosin compared with placebo also showed significantly improved anxiety, depression, and alcohol craving over the course of the trial. The findings indicate that alcohol withdrawal symptoms are a significant moderator of prazosin treatment response for alcohol use outcomes and for associated symptoms of alcohol craving, anxiety, and mood symptoms. These data support further evaluation of alcohol withdrawal symptoms as a prognostic indicator of prazosin's efficacy in the treatment of AUD.

Effects of chronic prazosin, an alpha-1 adrenergic antagonist, on anxiety-like behavior and cortisol levels in a chronic unpredictable stress model in zebrafish (Danio rerio).

Post-traumatic stress disorder (PTSD) is often associated with significant neuroendocrine dysfunction and a variety of other symptoms. Today, there are limited efficacious treatment options for PTSD, none of which directly target the dysfunction observed with the hypothalamic-pituitary-adrenal (HPA) axis. The development of new pharmacological treatments is expensive and time consuming; thus, there is utility in repurposing compounds already approved for use in other conditions. One medication in particular that has shown promise for the alleviation of PTSD symptoms is prazosin, an alpha-1 adrenergic receptor antagonist used to treat hypertension. While there have been many studies indicating the efficacy of prazosin in the treatment of PTSD symptoms, no studies fully elucidate mechanisms elicited by this treatment, nor is it clear if prazosin normalizes neuroendocrine dysfunction associated with trauma exposure. The use of zebrafish (Danio rerio) has been growing in popularity, in part, due to the homology of the stress response system with mammals. In this study, the zebrafish model was utilized to determine behavioral and biological changes induced by chronic unpredictable stress (CUS) and how these effects could be modulated by chronic prazosin treatment. The results indicated that 7d of CUS increased anxiety-like behavior in the novel tank test and decreased basal levels of cortisol. Chronic (7d) prazosin treatment decreased anxiety-like behaviors overall but did not appear to affect CUS-induced changes in behavior and basal cortisol levels. This suggests that the clinical effectiveness of prazosin may not normalize dysregulated stress responses prevalent in many patients with PTSD, but that prazosin-induced relief from anxiety in stress-related conditions may involve an alternative mechanism other than by normalizing neuroendocrine dysfunction.

2.34 Efficacy and Tolerability of Prazosin for PTSD in Adolescents During Inpatient Psychiatric Hospitalization

PTSD is common in adolescents exposed to trauma, and associated nightmares may affect the symptom severity. Prazosin, an α-adrenergic antagonist, has been associated with decreased nightmares in adults and adolescents in small studies, primarily in the ambulatory setting. In this study, we retrospectively evaluated the tolerability and efficacy of prazosin in adolescents with PTSD during inpatient psychiatric hospitalization.

Efficacy of Prazosin and Nifedipine in Medical Expulsion Therapy of Ureteric Stones, - A Prospective study

Efficacy of Prazosin and Nifedipine in Medical Expulsion Therapy of Ureteric Stones, - A Prospective study

Efficacy of Prazosin in Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.

To consolidate the evidence from the literature to evaluate the role of prazosin in the treatment of posttraumatic stress disorder (PTSD). Major databases, including PubMed, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Ovid PsycINFO, and Scopus, were searched through August 2015 for studies reporting the role of prazosin in the treatment of PTSD with no language constraints. Keywords included (PTSD OR posttraumatic stress OR posttraumatic stress OR nightmares) AND prazosin. Of 402 screened articles, 6 studies were included in the systematic review and meta-analysis. Two reviewers independently extracted relevant data (study characteristics, type of intervention, outcome measures, and follow-up) from the included studies using a standardized data extraction form. Only randomized controlled trials comparing prazosin to a placebo or control group in patients with PTSD were included. The patients with PTSD receiving prazosin showed significant improvement in nightmares (standardized mean difference [SMD] = 1.01; 95% CI, 0.72-1.30), overall PTSD symptoms (SMD = 0.77; 95% CI, 0.48-1.06), and clinical global improvement (SMD = 0.94; 95%, CI 0.6-1.29) compared to the placebo/control group. Prazosin improved sleep quality (SMD = 0.87; 95% CI, 0.55-1.19), hyperarousal symptoms (SMD = 1.04; 95% CI, 0.23-1.84), dream content (SMD = 1.33; 95% CI, 0.69-1.97), and total sleep time (60.98 minutes; 95% CI, 18.69-103.26). Prazosin was fairly well tolerated. Minor side effects were reported, which were similar between the prazosin and placebo groups. This study suggests that prazosin improves nightmares and overall PTSD symptoms including hyperarousal, sleep disturbances, total sleep time, and sleep quality.

Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmares, sleep disturbance and post-traumatic stress

Introduction The medication, Prazosin, and the psychological treatment known as imagery rehearsal therapy (IRT) have both proven effective for the treatment for post-traumatic stress disorder-associated nightmares.Whereas one recent meta-analysis compares their efficacy for reducing nightmares, their effects on other relevant outcomes, such as sleep quality and post-traumatic stress disorder symptoms (PSS) have not been compared.In this meta-analysis, we compared the short-term efficacy of prazosin and IRT on nightmares, sleep quality and PSS. Materials and methods Reference databases (PubMed, PsycInfo, Google Scholar, Cochrane Library and Web of Knowledge) were searched for studies using IRT or prazosin for nightmares, general sleep disturbance, and/or symptoms of post-traumatic stress.Inclusion criteria were (1) use of a randomized controlled trial design and (2) reporting of treatment outcomes in sufficient detail to calculate effect sizes. Effect sizes (Cohen’s d) were calculated by subtracting the mean post-test score (defined as the first assessment following treatment) in the control group from the mean post-test score in the treatment group, and dividing the result by the pooled standard deviation of both groups. Mixed effects models were performed to evaluate the effect of treatment characteristics on treatment efficacy. Results Fourteen studies with a total of 850 subjects were included.Among these, 3 studies used prazosin, 10 used IRT and 1 included a group of subjects receiving prazosin and a group of subjects receiving IRT. Statistically significant improvements for all IRT comparisons combined (n = 12), and for all prazosin studies combined (n = 4) were found for nightmare frequency (d = 0.55; p 0.01 and d = 0.43; p 0.05, respectively), sleep quality (d = 0.54; p 0.01 and d = 0.70; p 0.01, respectively), and PSS (d = 0.51; p 0.01 and d = 0.69; p 0.01.The difference between the average effect sizes of the IRT studies and those of the prazosin studies was not statistically significant across all three treatment outcomes.However, interventions combining IRT and cognitive-behavioral therapy for insomnia (CBT-I) (n = 3) resulted in greater improvements in sleep quality and PSS than interventions including IRT alone (n = 5) (p 0.05 for sleep quality and p 0.05 for PSS) or IRT combined with other psychological interventions (e.g.lucid dreaming; n = 4: p 0.01 for sleep quality and p 0.05 for PSS). Conclusion Overall, IRT and prazosin have documented and comparable acute effects for the treatment of nightmares, sleep disturbance and PSS. Furthermore, CBT-I seems to be a useful addition to IRT to enhance treatment outcomes. More randomized clinical trials that compare the short- and longer term effects of IRT, prazosin and their combination are warranted. Acknowledgements Fundacion Seneca. Murcia, Spain.

Prazosin treatment of nightmares related to post-traumatic stress disorder

This case demonstrates the efficacy of prazosin in treating civilian post traumatic stress disorder (PTSD)-related nightmares. Although its mechanism is not fully elucidated, it is clear that prazosin decreases nightmares. Tolerability may limit one's ability to titrate to an effective dose.

Skin Cells Reprogrammed to Be Stem Cells

potential therapeutic benefits of beta-blockers for PTSD. A multiinstitution team of researchers led by Karim Nader, PhD, of the McGill University in Montreal, Quebec, presented preliminary evidence from a small double-blind trial that treatment with beta-blockers may weaken the physiologic effects of traumarelated memories in patients with PTSD. The team asked 19 individuals with long-term PTSD to describe their traumatic event, and subsequently randomized the individuals to receive either propranolol or placebo for 24 hours. One week later the researchers measured physiologic responses, including heart rate and sweat, while the patients participated in script-driven mental imagery of their traumatic event. Physiologic responses were significantly smaller in the treated group. Other researchers are probing the efficacy of prazosin, a drug used to treat hypertension and enlarged prostate. Previously, researchers had demonstrated that prazosin helps reduce nightmares and other sleep disturbances in patients with PTSD (Raskind MA et al. Biol Psychiatry. 2007; 61[8]:928-934). Now, a team of researchers from the Oregon Health and Science University and Portland Veterans Affairs Medical Center is probing whether the drug might one day be used to help prevent PTSD from developing in individuals who are exposed to trauma. S. Paul Berger, MD, a member of the team, explained that prazosin, an 1-adrenoceptor antagonist, or a similar drug might be able to prevent neuronal injury caused by elevated levels of corticosteroids in the brain. Such elevated levels of corticosteroids have been documented in PTSD and other brain disorders such as Alzheimer disease and schizophrenia. Berger and colleagues presented data at the meeting that suggested pretreating rats with prazosin or labetalol, a nonspecific adrenoceptor antagonist, reduced neuronal damage (as measured by expression of heat shock protein) in rats treated with the glucocorticosteroid dexamethasone. Additional studies are necessary to determine if these types of drugs reduce the behavioral problems associated with such damage in rat models of the disorder. If further research supports the neuroprotective benefits of prazosin, Berger envisions the drug being used to treat patients within a week or 2 of their exposure to trauma in hopes of preventing the development of PTSD.

Prevention of Postherniorrhaphy Urinary Retention with Prazosin

Urinary retention that necessitates catheterization after herniorrhaphy is a well known, but usually ignored, situation. Increased sympathetic activity resulting from surgery may be the contributing factor. Blockade of alpha receptors in the bladder neck and urethral sphincter may prevent postoperative urinary retention. In this prospective placebo-controlled study, the efficacy of prazosin in preventing postoperative urinary retention after herniorrhaphy was investigated in 156 patients. Patients were randomized into two groups. Patients in Group I (control) were given placebo orally 12 hours before surgery, just before surgery, and 12 and 24 hours after surgery. In Group II, 1 mg of prazosin was given in the same manner of placebo. Nine of 84 patients (10.8%) in the prazosin group and 18 of 72 patients (25%) in the placebo group developed urinary retention. Catheterization was required in only 3 patients (3.5%) in the prazosin group compared to 10 patients (13.8%) in placebo-treated group (P < 0.05). In conclusion, prophylactic use of prazosin after herniorrhaphy significantly reduced the incidence of urinary retention and catheterization.

A Placebo Controlled Double Blind Study Using Perioperative Prazosin in the Prevention of Urinary Retention Following Inguinal Hernia Repair

Acute urinary retention is a frequent complication following inguinal hernia repair. The smooth muscle of the bladder neck and the prostate have been demonstrated to be rich in alpha-1 adrenergic receptors. It has been postulated that the aetiology of acute urinary retention postoperatively is at least partially due to adrenergic stimulation, blocking these receptors may reduce the incidence of acute urinary retention. We have used prazosin in a double blind, placebo controlled study to establish its efficacy in the prevention of acute urinary retention in patients undergoing elective inguinal hernia repair. A total of 70 male patients were enrolled; 36 patients had been allocated active drug and 34 patients had been allocated placebo. Only two patients developed acute urinary retention. Both patients had been allocated prazosin and had received a general anaesthetic for their hernia surgery. In either arm of the study, a higher number of patients developing urinary retention would have been expected but this may be explained by the greater vigilance on urinary output by nursing staff aware that the trial was being conducted. On the basis of our findings, we do not recommend the routine use of perioperative prazosin with inguinal hernia repair. Further studies in high risk groups would be necessary to assess more fully the efficacy of prazosin in this situation.

A Multicenter, Double-Blind, Placebo-Controlled Trial of the Efficacy of Prazosin in the Treatment of Dysuria Associated with Benign Prostatic Hypertrophy

An 8-center, double-blind, placebo-controlled trial of 39 patients with benign prostatic hypertrophy was conducted to assess the effects of prazosin HCl treatment on functional urologic variables after a treatment period of 4 weeks. The randomized groups were comparable for demographic variables and symptoms, except for the mean residual urinary volume, which was significantly higher in the prazosin HCl group. Prazosin HCl elicited statistically significant improvements in the mean prostatic urethral pressure and prostate area (Mann-Whitney U test: p = 0.001 for both variables as compared with the placebo group). Functional bladder capacity also improved significantly in the group receiving the test drug (Mann-Whitney U test: p = 0.05, as compared with the placebo group). Clinical improvements were also observed in the mean maximum urinary flow, decreased nocturia frequency, and residual urinary volume. Patient preference significantly favored the prazosin HCl treatment (Mann-Whitney U test: p = 0.001). Seven patients on prazosin HCl and 5 receiving placebo reported one or more side effects during the trial phase; these were mild to moderate and disappeared or were tolerated. No statistically significant effects on blood pressure or heart rate were observed.

In vitro and in vivo antiarrhythmic effects of prazosin in the rat.

The possible antiarrhythmic action of prazosin was studied on two experimental models: a focus of ectopic automaticity in the rat isolated right ventricle and arrhythmias induced by i.v. CaCl2 in anaesthetized animals. In vitro, prazosin at 10(-5)M abolished the ectopic automaticity focus in 83% of cases (10/12). The effects of prazosin were not modified by reserpine pretreatment. In vivo, prazosin modified the range of CaCl2 arrhythmias, reduced the mean control sinus rate (by 21.7% at 1 mg/kg), reduced incidence and mortality by ventricular fibrillation and lengthened survival time of animals that eventually died. The results indicate that antagonism of postsynaptic alpha 1-adrenoreceptors may partly explain the efficacy of prazosin against some experimental cardiac arrhythmias.

A comparison of prazosin versus nadolol in combination with a diuretic

The comparative efficacy and effects on total body potassium of prazosin and polythiazide vs nadolol and polythiazide in the treatment of patients with mild to moderate essential hypertension unresponsive to diuretic alone were compared in an open, crossover trial involving 20 male patients. Both prazosin and nadolol reduced blood pressure to goal values in both study phases. Side effects were minor, and only 1 patient dropped out of treatment for reasons unrelated to the study drugs. Neither prazosin nor nadolol in combination with thiazide had significant additional adverse effects on total body potassium. These findings confirm that the efficacy of prazosin is equivalent to that of nadolol in the long-term management of patients with essential hypertension.

Efficacy of prazosin in the management of chronic congestive heart failure: A 6-month randomized, double-blind, placebo-controlled study

The beneficial effects of acute prazosin therapy in patients with congestive heart failure (CHF) have been well documented; however, its chronic efficacy over several months has not previously been evaluated in a placebo-controlled manner. Therefore, an assessment was made by radionuclide ventriculography of the effect of prazosin, 20 mg/day, on left ventricular ejection fraction and end-systolic and end-diastolic volumes at rest and on peak upright bicycle exercise, as well as its effect on right ventricular ejection fraction at rest, exercise time and work load, and standard clinical variables in 23 patients with stable class III symptoms of CHF. The study consisted of a 6-month randomized, doubleblind, controlled evaluation of prazosin versus placebo in patients receiving a stable dose of digitalis and diuretics for at least 1 month. At entry, the prazosin and placebo groups did not differ in any respect. Prazosin caused no demonstrable effect on clinical variables such as status of symptoms, heart rate, mean arterial pressure, and cardiothoracic ratio when compared with placebo. Prazosin also caused no demonstrable effect compared with placebo on absolute or percent changes in radionuclide variables at rest or on peak exercise, or on exercise time or exercise work load. In addition, prazosin had no consistent effect compared with placebo on plasma renin activity or plasma catecholamine levels. However, there was a slight but significant increase in weight (p < 0.0001) and in plasma renin activity in the upright position (p < 0.002) with time, as well as a tendency for the diuretic dose to increase with time in both groups. Thus, long-term prazosin therapy generally produces no demonstrable subjective or objective improvement in patients with stable, chronic class III CHF receiving digitalis and diuretic therapy.

Prazosin in hypertension with and without methyldopa

The efficacy of prazosin was assessed in 21 patients with essential hypertension who failed to respond adequately to a combination of methyldopa and hydrochlorothiazide. The patients were divided randomly into two groups; in the first group prazosin was substituted for methyldopa and in the second group prazosin was added to the combination. In group 1, the average blood pressure (BP) fell from 144/102 mmHg (sitting) and 142/105 mmHg (standing) to 136/91 mmHg (sitting) and 129/91 mmHg (standing) after prazosin (17 mg) was substituted for methyldopa. The fall in the diastolic BP was statistically significant (p less than 0.01). In group 2, BP fell from 146/101 mmHg (sitting) and 143/103 mmHg (standing) to 126/87 mmHg (sitting) and 118/86 mmHg (standing) when prazosin 14 mg was added to methyldopa and hydrochlorothiazide. The reductions in systolic and diastolic pressures were statistically significant (p less than 0.001).