Prazosin—a medication commonly used to treat high blood pressure—may also reduce drinking by adults with alcohol use disorder (AUD), according to a clinical trial involving active-duty military appearing in Alcohol: Clinical and Experimental Research. Adults with elevated heart rate or blood pressure seemed to benefit the most from this medication.
Murray Raskind, M.D., of the VA Puget Sound Health Care System and colleagues enrolled 102 active-duty soldiers (95% male) who were participating in a mandated Army outpatient alcohol treatment program. All participants had to be in good overall health, meet DSM-IV criteria for alcohol abuse or dependence, and be free of any psychotic or manic symptoms and any other substance use disorder except nicotine. The participants were randomized to receive 13 weeks of prazosin (titrated up to 20 mg daily) or placebo. For the first nine weeks, the participants were in the outpatient alcohol treatment program while also taking the medication; for the final four weeks, the participants received only the medication.
After nine weeks, the soldiers who were taking prazosin reported significantly less drinking from baseline than those who were taking placebo, quantified in standard drinking units (0.6 ounces of pure alcohol) per day. After 13 weeks, drinking levels remained lower in the prazosin group relative to placebo, though the difference was no longer statistically significant. There were also no significant differences in the number of drinking days or alcohol craving scores between the groups at 9 or 13 weeks.
Raskind and colleagues next analyzed the data by subgroups. They found that participants with comorbid AUD and posttraumatic stress disorder (n=48) who were taking prazosin reported statistically fewer cravings than those taking placebo after 13 weeks. Likewise, participants with an elevated standing heart rate (≥ 90 beats per minute) or systolic blood pressure (≥ 130 mmHg) in the prazosin group had statistically fewer drinks and fewer drinking days (both almost at zero) than those in the placebo group. The benefits of prazosin relative to placebo were more evident in these participants between weeks 9 and 13.
“[T]he greater clinical impact of prazosin in the last 4 weeks of the current trial that followed completion of formal alcohol treatment program participation suggests potential benefit of prazosin for alcohol relapse prevention,” Raskind and colleagues wrote. “These observations provide rationale for an extended-duration prospective relapse prevention [trial] of prazosin in … persons with AUD who have recently achieved abstinence but continue to experience alcohol withdrawal signs and symptoms and/or elevated cardiovascular parameters.”
To read more on this topic, see the Psychiatric News article “Can Ketamine Curb Excess Drinking?”
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