Prazosin is effective at reducing alcohol consumption in adults with alcohol use disorder (AUD) and severe withdrawal symptoms such as sweating, headache, and nausea, reports a study in AJP in Advance.
In a 12-week, randomized clinical trial of 112 treatment-seeking adults with AUD, those with severe withdrawal symptoms who took prazosin had half as many drinking days and only one-fifth the number of heavy drinking days as adults with severe withdrawal symptoms taking placebo. In contrast, there was no difference in drinking days between participants taking prazosin who were experiencing few or no symptoms of alcohol withdrawal and those taking placebo.
“In parallel, we found that the higher the alcohol withdrawal symptom severity, the greater the benefit of prazosin in reducing anxiety, depressed mood, and alcohol craving over the course of the trial,” wrote Rajita Sinha, Ph.D., of Yale University School of Medicine and colleagues. “These findings support the speculation that prazosin’s benefits may be mediated by its effects on the high craving, negative mood, and anxiety that are clinically observed in those with greater alcohol withdrawal symptom severity.”
Sinha and colleagues randomized adults with AUD to receive either 16 mg/day prazosin or placebo along with weekly behavioral counseling sessions for 12 weeks. At baseline, the participants’ withdrawal symptoms were assessed using the Clinical Institute Withdrawal Assessment for Alcohol–Revised. The participants were then divided into low/no-withdrawal and high-withdrawal groups.
The participants reported their drinking each day using their smartphones or automated voice messaging. Additionally, the researchers evaluated the patients’ vital signs, medication adherence, and breath alcohol levels during biweekly outpatient visits.
At 12 weeks, adults in the high-withdrawal group taking prazosin reported drinking on 27.46% of total days and heavy drinking (four to five drinks per day) on 7.07% of days, while those on placebo reported drinking 58.47% of total days and heavy drinking on 35.58% of days. The researchers found no benefit of prazosin among adults with low or no withdrawal symptoms.
Prazosin was found to be safe and well tolerated, and there were no significant differences in medication adherence between the prazosin and placebo groups, the authors added.
To read more on this topic, see the Psychiatric News article “Gabapentin Found to Work Best for Those With Severe Alcohol Withdrawal Syndrome.”