Ketamine-Prazosin Combined Pharmacotherapy in Post-Traumatic Stress Disorder and Alcohol Use Disorder: Targeting Complementary Neurobiological Mechanisms.

Posttraumatic Stress Disorder (PTSD) and Alcohol Use Disorder (AUD) often co-occur, worsening outcomes, relapse rates, and treatment response. Ketamine produces rapid and sustained PTSD symptom reduction and reduces AUD relapse. Prazosin effectively treats PTSD-related nightmares and may reduce alcohol consumption in individuals with heightened autonomic reactivity. The dual complementary mechanisms, modulation of glutamatergic neurotransmission and attenuation of noradrenergic hyperactivity, provide a compelling rationale for combination pharmacotherapy. Potential benefits include improved stabilization, readiness for trauma-focused therapy, and broader symptom control. Although untested in clinical trials, this approach warrants nurse practitioner-led research to evaluate safety, efficacy, and integration into multidisciplinary care.