Category: Federal Forum Posters
Purpose: Noradrenergic activity, such as nightmares and night sweats, commonly affect individuals with past trauma related events. Many veterans report these symptoms which are also associated with a reduced quality and length of sleep. Prazosin has previously been studied to reduce excessive noradrenergic brain activity. The purpose of this retrospective chart review is to evaluate the use of doxazosin in a veteran population. Doxazosin, an inhibitor of postsynaptic alpha-1 adrenergic receptors in both the brain and peripheral nervous system, is hypothesized to be a potentially effective and tolerable treatment alternative to prazosin.
Methods: This retrospective chart review included veterans prescribed doxazosin at our facility. Inclusion criteria consisted of (1) reported symptoms of nightmares or night sweats, (2) started on doxazosin from September 1, 2015 to January 31, 2017, and (3) at least one follow-up appointment with the initiating provider. Exclusion criteria consisted of (1) doxazosin prescribed solely for prostate, bladder, or hypertension, (2) concomitant non-uroselective alpha-antagonists, (3) documented allergy or anaphylaxis to doxazosin, (4) report of not taking doxazosin or did not fill the prescription, and (5) did to follow up with the provider after the first prescription. The primary endpoints of this retrospective chart review were percent differences in nightmares and night sweats. The secondary endpoints were percent increase in average sleep length per night, average optimal dose of doxazosin, and incidence of adverse effects. Chart reviews were conducted beginning with the date of initial doxazosin prescription until end of therapy, or until the last visit prior to July 31, 2017 when data collection ended.
Results: During the review period, 225 charts were screened, and 132 of those charts met the inclusion criteria. Nightmares were present for 94 veterans. With doxazosin therapy, the average reduction in nightmares was 38 percent (1.1 less nights per week). Night sweats were initially reported for 64 veterans. With doxazosin, night sweats were reduced by an average of 27 percent (0.9 less nights per week). For the secondary outcomes, average sleep length per night increased by 0.2 hours (range: 0 to 5 hours per night), the average dose of doxazosin was 5.3 mg (range: 0.5 to 20 mg/day), and adverse effects occurred in 55 percent of individuals. The most common adverse effects reported with doxazosin within this review were lightheadedness (23 percent), drowsiness (21 percent), and dizziness (16 percent). No veterans experienced serious adverse effects.
Conclusion: Doxazosin appears to be effective for reducing nightmares and night sweats in this veteran population, regardless of mental health diagnosis, co-occurring sleep disorders, or substance use. Additional studies may further elucidate its utility within the Veterans Affairs Health Care System as well as in other populations.
David Charlestham– Clinical Pharmacy Specialist, Mental Health, Veterans Affairs, Central California Health Care System, Fresno, CA