Nightmare Meta-Analysis Did Not Support a Clonazepam Recommendation

The overall medication effect cannot be assigned to every drug included in the review.

What the publication shows

The review identified fourteen placebo-controlled randomized studies involving 830 participants. Most concerned prazosin in PTSD-related nightmares. Other agents included clonazepam, but the authors concluded that their synthesis did not provide a basis for recommending clonazepam for nightmares.

Limits of the evidence

Evidence was unevenly distributed among drugs, and several agents had only one small study. Nightmare frequency, distress and intensity are different outcomes. A positive overall pooled effect across heterogeneous medicines is not a clonazepam-specific efficacy estimate.

Application to expert review

For a treatment opinion, identify the drug-specific evidence and the diagnosis being treated. Do not transfer results for prazosin or nabilone to a benzodiazepine. Distinguish lack of supporting evidence from proof that no individual could improve, while preserving uncertainty about benefits and harms.

Source and related reading

Source: Publication PMC9820008. The case-review applications above are interpretive analysis.