Alcohol withdrawal symptoms moderate efficacy of prazosin
30 May 2021
Alcohol withdrawal symptoms significantly moderate prazosin treatment response for alcohol use outcomes and for associated symptoms of alcohol craving, anxiety, and mood symptoms, reveals a recent study.
“Alcohol use disorder (AUD) is a leading cause of global disease burden,” the authors said. “Chronic, heavy use increases the likelihood of alcohol withdrawal symptoms and associated secondary outcomes of alcohol craving and mood, anxiety, and sleep disturbances, which are predictive of poor treatment outcomes.”
The authors conducted this 12-week, double-blind, randomized, controlled proof-of-concept trial of prazosin (16 mg/day, with a 2-week titration) in community-recruited adults with current alcohol dependence (n=100) with varying levels of alcohol withdrawal symptoms assessed at treatment entry.
Daily self-reported drinking days and heavy drinking days were the primary endpoints, while secondary ones included average drinks/day and mood, anxiety, craving, and sleep quality ratings.
In modified intent-to-treat analyses, a significant interaction was noted in alcohol withdrawal symptom score by treatment by full-dose treatment period (weeks 3–12) for drinking days, heavy drinking days, and average drinks/day.
By week 12, participants with high alcohol withdrawal symptoms on prazosin had 7.07-percent heavy drinking days and 27.46-percent drinking days. Those on placebo reported 35.56-percent heavy drinking days (odds ratio [OR], 0.14, 95 percent confidence interval [CI], 0.058–0.333) and 58.47-percent drinking days (OR, 0.265, 95 percent CI, 0.146–0.481).
Prazosin provided no such benefit to those reporting low or no alcohol withdrawal symptoms. In addition, participants with high alcohol withdrawal symptoms on prazosin had significantly improved anxiety, depression, and alcohol craving relative to those on placebo over the course of the trial.
“These data support further evaluation of alcohol withdrawal symptoms as a prognostic indicator of prazosin’s efficacy in the treatment of AUD,” the authors said.