Use of Prazosin for Post-traumatic Stress Disorder in Adolescents is Associated with Longer Inpatient Psychiatric Hospitalization

Abstract

Objectives: Prazosin has been shown to be effective in reducing PTSD-related nightmares in adolescents in outpatient studies with modest sample sizes. There are no data on the effects of prazosin on length of inpatient psychiatric hospitalization. Given prazosin’s adverse effects, we hypothesize that prazosin initiation during inpatient psychiatric hospitalization is associated with prolonged length of stay. Patients and Methods: Retrospective chart review identified 255 psychiatric admissions of adolescents with PTSD from 2012-2017 at an academic medical center. The treatment group comprised 101 admissions during which prazosin was initiated. Given a lack of rating scales, number of concurrent diagnoses and discharge medications were used to approximate overall illness severity. Results: There were no statistical differences between the treatment and non-treatment (control) groups with respect to age, gender, number of diagnoses or discharge medications. The mean dose of prazosin was 1.5±0.7 mg nightly with mean duration of 7.6±6.1 days. Length of hospital stay was significantly longer for the prazosin group compared with controls (11.1±6.6 vs 9.5±5.8 days, p=0.04). There was no difference in rates of orthostatic hypotension between groups. Adverse reactions were observed in 41% of individuals taking prazosin with a discontinuation rate of 14% due to intolerable side effects, lack of efficacy or request to reduce polypharmacy. Conclusions: Treatment with prazosin during inpatient psychiatric hospitalization may be associated with increased length of stay for adolescents with PTSD. Further studies are needed to validate these results.