Document Detail


Prazosin versus quetiapine for nighttime posttraumatic stress disorder symptoms in veterans: an assessment of long-term comparative effectiveness and safety.
MedLine Citation:
PMID:  20473055     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Posttraumatic stress disorder (PTSD) is an anxiety disorder experienced by combat veterans. Nighttime symptoms are often unrelieved by selective serotonin reuptake inhibitor therapy, and increased use of prazosin or quetiapine for treatment is seen. The purpose of this study was to determine the short- and long-term effectiveness and safety of prazosin versus quetiapine for treating nighttime symptoms in veteran PTSD patients. This is a historical prospective cohort study using retrospective chart review. Three hundred twenty-four patients with a diagnosis of PTSD, based on International Classification of Diseases, Ninth Revision coding, who were initially prescribed prazosin or quetiapine for nighttime symptoms were screened for inclusion. Short-term effectiveness was determined by documentation of symptomatic improvement within 6 months, and long-term effectiveness if patients continued therapy to study end date. Safety was assessed by comparing incidence of adverse drug effects causing discontinuation of either study drug. This study included 237 patients: 62 received prazosin, and 175 received quetiapine. Short-term effectiveness was similar for prazosin (61.3%) and quetiapine (61.7%; P = 0.54). However, patients prescribed prazosin were significantly more likely to continue their therapy to study end date compared with quetiapine (48.4% vs 24%; P < 0.001; odds ratio, 3.0; 95% confidence interval, 1.62-5.45), thus achieving long-term effectiveness. Alternatively, patients in the quetiapine group were more likely to discontinue therapy because of adverse effects compared with the prazosin group (34.9% vs 17.7%; P = 0.008). Because of similar rate of short-term effectiveness, superior long-term effectiveness, and lower incidence of events leading to discontinuation, compared with quetiapine, prazosin should be used first-line for treating nighttime PTSD symptoms in a veteran population.
Authors:
Melanie G Byers; Kristen M Allison; Christopher S Wendel; Jeannie K Lee
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of clinical psychopharmacology     Volume:  30     ISSN:  1533-712X     ISO Abbreviation:  J Clin Psychopharmacol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-17     Completed Date:  2011-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8109496     Medline TA:  J Clin Psychopharmacol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  225-9     Citation Subset:  IM    
Affiliation:
Southern Arizona VA Health Care System, Tucson, AZ, USA. melaniegbyers@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Arizona
Cohort Studies
Dibenzothiazepines / adverse effects,  therapeutic use*
Female
Humans
Male
Middle Aged
Prazosin / adverse effects,  therapeutic use*
Prospective Studies
Retrospective Studies
Sleep Disorders / complications,  drug therapy*,  psychology
Stress Disorders, Post-Traumatic / complications,  drug therapy*,  psychology
Time Factors
Treatment Outcome
United States
United States Department of Veterans Affairs
Veterans / psychology*
Young Adult
Chemical
Reg. No./Substance:
0/Dibenzothiazepines; 0/quetiapine; 19216-56-9/Prazosin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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