Can Prazosin Be Used to Treat Alcohol Dependence?

Prazosin, an alpha-1 adrenergic antagonist, may reduce central nervous system adrenergic activity and disrupt alcohol reinforcement and relapse. To assess the potential of prazosin to treat alcohol dependence, researchers randomized 24 persons with alcohol dependence (mean age, 45 years; 79% male, 83% white) to prazosin (target dose, 4 mg in the morning and evening and 8 mg at bedtime) or placebo. Over the 6-week study period, participants attended 5 medical management sessions* and carried a text pager that reminded them 3 times each day to take medications and once each day to call a telephone system for alcohol self-report.

• Among the 24 participants, there was no difference between prazosin and placebo in change from baseline to 6 weeks for drinking days per week and mean drinks per week.

• Among the 20 participants who completed the study, those in the prazosin group reported fewer drinking days per week than the placebo group (3.2 days versus 5.6 days) over the last 3 weeks of the study, but there was no difference between groups in mean drinks per week.

• Among men who completed the study (n=17), those in the prazosin group reported fewer drinking days per week (0.9 days versus 5.7 days) and mean drinks per week (2.6 drinks versus 20.8 drinks) than the placebo group over the last 3 weeks of the study.

• Craving and craving resistance did not differ between the 2 groups.

Comments:

This small pilot study suggests prazosin may have potential for treating alcohol dependence. The researchers believe the restriction of benefit to the last 3 weeks of the 6-week study was because prazosin was not titrated to full dose until the end of week 2. Larger studies will be needed to fully assess the efficacy of prazosin for treating alcohol dependence.

Kevin L. Kraemer, MD, MSc

Reference:

Simpson TL, Saxon AJ, Meredith CW, et al. A pilot trial of the alpha-1 adrenergic antagonist, prazosin, for alcohol dependence. Alcohol Clin Exp Res. 2008;32(11);1–9.