Adults with severe alcohol use disorder (AUD) who took a combination of a generic antihypertensive and antihistamine reduced their daily alcohol consumption by about 24 grams—nearly the amount in two standard drinks—over those taking a placebo, according to a report in Addiction.
“Considering the small number of approved medications and current limited use of pharmacotherapy for AUD, all with limited-to-moderate efficacy, patients with AUD as well as their physicians [need] additional treatments,” wrote lead author Henri-Jean Aubin of the Université Paris-Saclay in Villejuif, France, and colleagues.
Aubin and colleagues suggested that cyproheptadine, an anti-allergic medication, and prazosin, which treats hypertension and urinary urgency, might work well together. The former targets receptors involved in impulsive behaviors, and the latter targets receptors related to cravings.
The researchers recruited 154 adults who met DSM-5 criteria for severe AUD and had a high-risk drinking level, defined as consumption of more than 60 grams of alcohol a day for men or 40 grams for women; a standard drink such as a bottle of beer, glass of wine, or shot of liquor contains 14 grams of alcohol.
Participants received 12 weeks of either a high dose medication regimen (10 mg prazosin plus 12 mg cyproheptadine daily), low dose regimen (5 mg prazosin plus 8 mg cyproheptadine daily), or placebo. All participants received brief, simple psychosocial support focused on treatment adherence and reduction of alcohol consumption. The researchers used alcohol consumption as the primary outcome because they noted that people with AUD are increasingly interested in drinking reduction goals rather than achieving abstinence.
After 12 weeks, participants taking the high or low dose regimen reduced their alcohol consumption by 23.6 grams and 18.4 grams more than the placebo group, respectively. A separate analysis of adults with a very high-risk drinking level (more than 100 grams of alcohol a day for men and 60 grams a day for women) showed that they experienced an even larger response to the high-dose treatment: These adults reduced their drinking by 29.8 grams a day on average over placebo.
Both dosing regimens were well tolerated; a review of all significant adverse events study-wide deemed them unlikely to be related to the study drugs.
“The promising efficacy of the combination of prazosin and cyproheptadine warrants prolonging this work with phase 3 trials,” the researchers concluded.
For related information, see the Psychiatric News article “Special Report: Psychiatrists Critical in Screening, Treatment of Alcohol Use Disorder.”
(Image: Getty Images/iStock/Ranimiro Lotufo Neto)
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