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Prazosin for nightmares in serious illness
Wil Santivasi1, Erin Taylor2, April Christensen2
1Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA santivasi.wil@mayo.edu.
BMJ Supportive & Palliative Care
|January 28, 2021
Summary
Prazosin effectively resolved nightmares in a patient with metastatic breast cancer receiving palliative care. This case highlights prazosin as a potential treatment for nightmares in serious illness outside of post-traumatic stress disorder.
Area of Science:
- Palliative Care
- Pharmacology
- Neurology
Background:
- Nightmares are a common and distressing symptom for patients with serious illnesses.
- Prazosin, an alpha-1 adrenergic antagonist, is primarily studied for nightmare treatment in post-traumatic stress disorder (PTSD).
- Existing treatments for nightmares in serious illness are often ineffective.
Observation:
- A 60-year-old woman with metastatic breast cancer developed healthcare-associated nightmares post-hospitalization.
- The patient did not meet diagnostic criteria for PTSD.
- Conventional treatments including atypical antipsychotics and benzodiazepines failed to alleviate her nightmares.
Findings:
- Prazosin was administered in an outpatient palliative medicine setting.
- The patient received prazosin alongside interdisciplinary psychosocial support.
- Rapid and complete resolution of nightmares was observed following prazosin initiation.
Implications:
- This case suggests prazosin may be a viable treatment option for nightmares in palliative care patients.
- It expands the potential therapeutic applications of prazosin beyond PTSD.
- Further research is warranted to explore prazosin's efficacy and safety in managing nightmares in serious illness.
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