Doxazosin for the Treatment of Nightmares in Post-Traumatic Stress Disorder: A Scoping Review of Clinical Evidence

Abstract

Post-traumatic stress disorder is a debilitating condition caused after exposure to a traumatic event.

One of the most difficult symptoms to treat is nightmares and sleep disturbances. There are limited

pharmacological treatment options, and all are off-label in most countries. Evidence suggests that

hyperstimulation of α1-adrenergic receptors in the prefrontal cortex contributes to hyperarousal,

trauma-related nightmares, and sleep disturbances. Over the past 30 years, patients with this condition

have been treated mostly with the first-generation α1-adrenergic antagonist prazosin. Doxazosin, a

third-generation α1-adrenergic blocker, has been less extensively studied for such symptoms. Embase,

PubMed, Cochrane, Google Scholar, and clinicaltrials.gov were searched from 1995 to 2025 to identify

studies that reported doxazosin treatment in adults with a clinical diagnosis of post-traumatic stress

disorder and nightmares and/or sleep disturbances. Out of the 143 reviewed articles, a total of 8 studies

were included in this review. Across all included studies, doxazosin demonstrated positive effects in the

treatment of nightmares. The methodological strengths and limitations, as well as results and outcome

measures for each study, are discussed. The aim of this scoping review is to map existing evidence,

identify knowledge gaps, and assess if doxazosin can be an appropriate therapeutic option. Although

evidence supporting doxazosin as a treatment for nightmares in post-traumatic stress disorder is promising,

the current body of evidence is very limited. Further research is needed to support the efficacy of

doxazosin in diverse patient populations.

Cite this article as: Perez IC, Korsavva S., Doxazosin for the treatment of nightmares in post-traumatic stress disorder: a

scoping review of clinical evidence. Neuropsychiatr Invest. 2025, 63, 0022, doi:10.5152/NeuropsychiatricInvest.2025.25022.