New Haven, CT—A drug originally FDA-approved more than 40 years ago for hypertension now is showing promise in helping those seeking treatment for alcohol-abuse disorders.
The report in the American Journal of Psychiatry suggests that prazosin can help those patients with withdrawal symptoms reduce or eliminate their drinking.
Yale University–led researchers conducted a double-blind study, providing either prazosin or a placebo to 100 people entering outpatient treatment after being diagnosed with alcohol-use disorder. Prior to initiating treatment, all participants had experienced varying degrees of withdrawal symptoms.
The authors point out that prazosin-group patients with more severe symptoms—shakes, heightened cravings, and anxiety and difficulty sleeping—showed a significant reduction in their heavy-drinking episodes and days they drank compared with those who received a placebo. On those without withdrawal symptoms, however, the drug had little effect.
“There has been no treatment readily available for people who experience severe withdrawal symptoms and these are the people at highest risk of relapse and are most likely to end up in hospital emergency rooms,” explained corresponding author Rajita Sinha, PhD, the Foundations Fund Professor of Psychiatry, a professor of neuroscience, and director of the Yale Stress Center.
Prazosin, which still is regularly used to relieve prostate issues in men, among other conditions, works on the stress center in the brain, improving working memory and curbing anxiety and cravings, according to background information in the article.
The 12-week, double-blind, randomized, controlled proof-of-concept trial of prazosin—6 mg/day, with a 2-week titration) was conducted in 100 community-recruited adults with current alcohol dependence. Defined as primary outcomes were daily self-reported drinking days and heavy-drinking days, while secondary outcomes were average drinks/day and mood, anxiety, craving, and sleep-quality ratings.
Researchers report that modified intent-to-treat analyses indicated a significant interaction of alcohol-withdrawal symptom score within the full-dose treatment period of prazosin (weeks 3–12) for drinking days, heavy-drinking days, and average drinks/day.
In fact, the study advises that, by week 12, participants with high alcohol withdrawal symptoms on prazosin reported 7.07% heavy-drinking days and 27.46% drinking days, while those on placebo had 35.58% heavy-drinking days and 58.47% drinking days (heavy-drinking days: odds ratio = 0.14, 95% CI = 0.058, 0.333; drinking days: odds ratio = 0.265, 95% CI = 0.146, 0.481).
“No such benefit of prazosin was observed in those reporting low or no alcohol withdrawal symptoms,” the authors write. “Individuals with high alcohol withdrawal symptoms on prazosin compared with placebo also showed significantly improved anxiety, depression, and alcohol craving over the course of the trial.”
Researchers call for further evaluation of the use of prazosin in treating alcohol-withdrawal symptoms. Dr. Sinha cautioned, however, that one limitation is that the current form of prazosin requires three-times-a-day administration to be effective.
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