Prazosin-Induced Hypotension

Introduction to Prazosin

• Prazosin is an alpha-1 adrenergic receptor antagonist used for treating PTSD-associated nightmares, recommended at Level A evidence by the American Academy of Sleep Medicine 3, 4
• The American College of Cardiology and the American Heart Association suggest that prazosin may be considered as a second-line agent for hypertension in patients with concomitant benign prostatic hyperplasia (BPH) 2, 5
• Prazosin is associated with orthostatic hypotension, especially in older adults, as reported by the American College of Cardiology 1, 2
• The typical dosing of prazosin is 2-20 mg/day, divided into 2-3 doses, according to the American College of Cardiology 2, 6

Clinical Presentation and Management

• Dizziness and lightheadedness are common symptoms of prazosin-induced hypotension, as noted by the American Academy of Sleep Medicine 3, 7
• The American Academy of Sleep Medicine recommends starting with a low dose (typically 1 mg at bedtime) and increasing by 1-2 mg every few days until reaching an effective dose 3, 4
• Clinicians should monitor for orthostatic hypotension, especially after the first dose, as advised by the American Academy of Sleep Medicine 3, 4

Patient Risk Factors

• Elderly patients are at higher risk for significant prazosin-induced hypotension, as reported by the American College of Cardiology and the American Heart Association 2, 6
• Patients on concurrent antihypertensive medications are also at higher risk, according to the American Heart Association 2