Prazosin (Minipress)
Prazosin is an alpha-1 adrenergic receptor blocker used in the pharmacological management of AD. By selectively blocking postsynaptic alpha-1 receptors, prazosin promotes vascular smooth muscle relaxation and reduces blood pressure with minimal direct effects on cardiac function. In adults, treatment is typically initiated at a low dose of 0.5–1 mg, administered two to three times daily, to safely manage hypertensive episodes.
Discussion
In a small (Krum et al. 1992), but high quality RCT, Prazosin twice daily was well tolerated and did not affect baseline blood pressure; AD episodes were also less severe and shorter in duration over a 2-week period. Phillips et al. (2015) found similar results during penile vibrostimulation trials, where Prazosin lowered systolic blood pressure when administered without affecting resting blood pressure.
Conclusion
There is level 1 evidence (from two RCTs) (Phillips et al. 2015; Krum et al. 1992), that Prazosin is superior to placebo in the prophylactic management of AD.
