This study examined the evidence of prazosin in the treatment of PTSD-related nightmares in children and adolescents. This study highlights limited data availability, out of 240 articles that were identified after an extensive literature search, only six studies, all case reports met the inclusion criteria. This systematic review highlights the effectiveness of prazosin in the reduction and frequency of nightmares, associated hyperarousal, and intrusive symptoms. This study indicates scarcity of evidence to guide physicians in the psychopharmacological treatment of PTSD. This study gives a compelling reason to conduct a large RCTs to determine the safety and effectiveness of Alpha-1 blocker to treat PTSD symptoms. Strengths: Extensive literature search from five large databases with no language restriction Critiques: The search terms used during the literature search do not include nightmares, psychological abuse, emotional abuse, physical abuse, sexual abuse, hyperarousal; these terms are used interchangeably with PTSD. The systematic review does not include studies where PTSD is a comorbid diagnosis such as studies on mood disorder where PTSD is a comorbid diagnosis. The inclusion criteria do not mention the age cut-off for studies that were included in the systematic review.