energy, weakness, palpitations, and nausea. Less frequent (1–4%) side effects include vomiting, diarrhea, constipation, edema, orthostatic hypotension, dyspnea, syncope, vertigo, depression, nervousness, nasal congestion and rash. A very rare side effect of prazosin is priapism. One phenomenon associated with prazosin is known as the "first dose response", in which the side effects of the drug specifically orthostatic hypotension, dizziness, and drowsiness are especially pronounced in the first dose. Orthostatic hypotension and syncope are associated with the body's poor ability to control blood pressure without active α-adrenergic receptors. The nasal congestion is exacerbated by changing body positions, because α1-adrenergic receptors also control nasal vascular blood flow and alpha blockers inhibit this, in the same way that alpha-adrenergic agonists have the opposite effect of being a decongestant. Pharmacology Pharmacodynamics Prazosin is an α1-blocker that acts as a non-selective inverse agonist at α1-adrenergic receptors, including of the α1A-, α1B-, and α1D-adrenergic receptor subtypes. It binds to these receptors with affinity (Ki) values of 0.13 to 1.0 nM for the α1Α-adrenergic receptor, 0.06 to 0.62 nM for the α1B-adrenergic receptor, and 0.06 to 0.38 nM for the α1D-adrenergic receptor. It has much lower affinity for the α2-adrenergic receptors (Ki = 210–5,012 nM for the α2A-adrenergic receptor, 13–398 nM for the α2B-adrenergic receptor, and 10–200 nM for the α2C-adrenergic receptor). The α1-adrenergic receptors are found in vascular smooth muscle, where they are responsible for the vasoconstrictive action of norepinephrine. They are also found throughout the central nervous system. α1-Adrenergic receptors have additionally been found on immune cells, where catecholamine binding can stimulate and enhance cytokine production. Pharmacokinetics Prazosin has an onset of action of 30 to 90 minutes, the elimination half-life of prazosin is 2 to 3 hours, and its duration of action is 10 to 24 hours. Research Prazosin has been said to be the only selective α1-adrenergic receptor antagonist which has been used in the treatment of insomnia to any significant degree. It is used at doses of 1 to 12 mg for this purpose. The combination of prazosin and the beta blocker timolol may produce greater sedative effects than either of them alone. Prazosin has been shown to prevent death in animal models of cytokine storm. As a repurposed drug, prazosin is being investigated for the prevention of cytokine storm syndrome and complications of COVID-19 where it is thought to decrease cytokine dysregulation. References External links Alpha-1 blockers Antihypertensive agents Anxiolytics Carboxamides