Prazosin (Minipress)
Antihypertensive (norepinephrine alpha-1 antagonist)
- PTSD1 (nightmares and daytime symptoms)
- Dementia (agitation and aggression)3
- Major Depression with history of trauma3
- Alcohol (use with cyproheptadine)2
Features
Dosing
Starting strategy for all conditions: Start 1 mg QHS, raise by 1–2 mg every 4-7 days based on response/tolerability. Above 3-5 mg, try moving 25% to morning. Target doses vary by condition.
PTSD: average dose is 12-16 mg (max of 25 mg/day for men and 12 mg/day for women).
Alcohol: 5-10 mg/day divided (mainly works with cyproheptadine 8-12 mg, though may help former alcohol users with problematic WD symptoms as monotherapy).
Dementia: 1-6 mg qhs
Depression: 1-2 mg qhs
Management
Warn of hypotension, check blood pressure during titration.
Improves nightmares, sleep, and daytime PTSD symptoms.
EMR Text
PTSD
Prazosin use based on multiple randomized controlled trials in PTSD, where it improved nightmares and daytime hypervigilance symptoms (Reist C et al, CNS Spectr 2021;26(4):338-344).
Prazosin side effects, including hypotension, reviewed with patient.
Dementia
Prazosin use based on a randomized controlled trial where it improved behavioral symptoms of dementia (Wang LY et al, Am J Geriatr Psychiatry. 2009;17(9):744-751).
Prazosin side effects, including hypotension, reviewed with patient.
Depression with Trauma
Prazosin use based on a randomized controlled trial where it improved depression in patients with a trauma history (Guo P et al, Acta Psychiatr Scand. 2025;151(2):142-151).
Prazosin side effects, including hypotension, reviewed with patient.