Results from a small pilot study were recently published in the journal of Alcoholism Clinical and Experimental Research,[1] the essay sheds light on the direction that clinicians might turn with the use of medicine to reduce alcohol cravings amongst abstinent and non-abstinent alcoholics. Animal studies have clearly established that the alpha-1 adrenergic receptor plays a prominent role in cravings and consumption reinforcement for many people who abuse and/or who are dependent on alcohol. The alpha-1 adrenergic receptor antagonist Prazosin was the subject of this Journal article. This drug is widely known by its brand name of Minipress. Prior editions of this newsletter have evaluated the use and efficacy of Campral (acamprosate), another drug that has been utilized to reduce alcohol cravings amongst abstinent alcoholics. Prazosin works differently than Campral; early results tend to indicate that Prazosin may be more effective and more profound in its effects.

Prazosin has been the source of medical and scientific curiosity for sometime. Originally brought to market as a drug to reduce blood pressure (anti-hypertensive), the drug was discovered to have some broader effects and capabilities. Besides the instant study where Prazosin’s alpha-1 adrenergic properties are linked to reductions in unwanted drinking and cravings, Prazosin has been successfully used to treat Post Traumatic Stress Disorder (PTSD). A number of published studies have seemingly established Prazosin’s abilities in reducing unwanted awakening and the incidence of frightening dreams for patients who suffer from PTSD. Many Iraq war veterans have been or are currently being treated with the drug. Interestingly, animal studies have suggested that the alpha-1 adrenergic receptor also mediates the desire for alcohol and the reinforcing effects that an alcohol abuser feels while he/she drinks.

Randomized experimental groups of twenty-four treatment seeking individuals were placed in a double-blind controlled study. One group was treated with placebo, the other with Prazosin. Patients were all classified as being alcohol dependent; none met the criteria established for PTSD. Other than attendance at regular Alcoholics Anonymous (AA) meetings, participants received no other treatment while participating in this study. Researchers made daily telephonic contact with participants to monitor and confirm that the Prazosin or placebo had been taken and to obtain the necessary self-report information. Participants in the experimental group were put on a regimen of Prazosin that titrated their daily doses incrementally upwards over the course of the 6-week study period.

The results from the 20 participants who completed the study were assessed; the data obtained over the course of the study’s final 3 weeks was especially clear in contrast, this was the period where maximum Prazosin dosage levels had been reached. The difference in the mean number of drinking days for participants taking Prazosin as compared to those taking placebo was startling, a near 84% reduction in the number of days for those who were taking Prazosin. The mean number of drinks consumed over the course of a week was very different. Those participants taking Prazosin presented a mean number of drinks consumed per week of 2.6, those participants assigned to placebo experienced a mean number of drinks/ consumed per week of 20.8. The Prazosin experimental group reported a mean of 88% fewer weekly drinks consumed compared to the placebo group’s mean weekly total number of drinks consumed.

A study such as this is very provocative and hopeful, but there were significant limitations to it. The small study size, the self-reporting of the effects and the limited number of women are all restraining factors. It’s likely that there will be an increased number of studies in the future that will build upon what has been uncovered. There are now several different drugs physicians can reach for in the battle to treat alcoholism. Vivitrol (naltrexone) is one proven therapy that can be considered in situations where there may be dubious control of a patient’s drinking and/or alcohol cravings. Campral (acamprosate) is clinically available.

Not addressed in this study is the value and potency of a 12-step sobriety program. Both groups, placebo and experimental continued their program engagements. It would be interesting to see what differences would exist between a Prazosin-only population and Prazosin therapy coupled with 12-step participation.

Readers with questions about this drug or other issues related to this topic can obtain assistance by emailing the MEDTOX DAR program at darsprogram@mac.com.

[1] Simpson TL et al. A pilot trial of the alpha-1 adrenergic antagonist prazosin for alcohol dependence. Alcohol Clin Exp Res 2009 Feb; 33:255.

Reproduced with permission from The MEDTOX® Journal