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Comparison of alpha-2 agonist versus alpha-1 antagonist for post-traumatic stress disorder-associated nightmares in

Seher Khalid1,2, Sandra Mitchell1, Cheryl Al-Mateen2

  • 1Clinical Pharmacy Specialist, Child and Adolescent Psychiatry, Virginia Commonwealth University Health System Department, Richmond, Virginia.

The Mental Health Clinician
|June 5, 2024
PubMed

Insights

Clonidine and guanfacine were effective for pediatric PTSD nightmares, similar to prazosin. Clonidine showed a faster reduction in nightmares compared to guanfacine in children with posttraumatic stress disorder (PTSD).

Area of Science:

  • Pediatric Psychiatry
  • Pharmacology
  • Sleep Medicine

Background:

  • Posttraumatic stress disorder (PTSD) in children and adolescents frequently co-occurs with sleep disturbances, particularly nightmares.
  • Current treatments for pediatric PTSD-related nightmares often rely on extrapolations from adult studies.
  • There is a need to evaluate specific pharmacologic interventions for this vulnerable population.

Purpose of the Study:

  • To determine the effectiveness and safety of alpha-2 agonists (clonidine, guanfacine) versus an alpha-1 antagonist (prazosin) for treating PTSD-related nightmares in pediatric patients.
  • To compare the efficacy and onset of action of clonidine and guanfacine within the alpha-2 agonist class.

Main Methods:

  • Retrospective review of medical records for patients aged 5-17 years admitted to an inpatient psychiatric unit.
  • Inclusion criteria: new initiation of clonidine, guanfacine, or prazosin with a diagnosis of PTSD or related disorders.
  • Primary endpoint: percentage of patients experiencing a reduction in nightmare frequency.

Main Results:

  • Both alpha-2 agonists and alpha-1 antagonists demonstrated high response rates in reducing nightmares (91.9% vs. 86.4%, respectively).
  • No statistically significant difference in overall nightmare reduction between the two drug classes.
  • Clonidine showed a significantly faster time to nightmare reduction (1.59 days) compared to guanfacine (3.18 days) (p=0.005).

Conclusions:

  • Alpha-2 agonists (clonidine, guanfacine) and alpha-1 antagonists (prazosin) are effective treatments for pediatric PTSD-associated nightmares.
  • Both medication classes exhibit a low incidence of adverse effects and a rapid onset of action.
  • Clonidine may offer a quicker resolution of nightmares compared to guanfacine in this pediatric population.
Abstract

Keywords:
PTSDclonidineguanfacinenightmarespediatricposttraumatic stress disorderprazosin

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