Published in the American Journal of Psychiatry, study data suggest that prazosin may be effective as harm-reduction treatment for individuals with alcohol use disorder.

Researchers designed a 12-week, double-blind, randomized controlled trial for patients with alcohol use disorder and without posttraumatic stress disorder. Participants (n=92) were randomly assigned to receive either prazosin or placebo at target doses of 4 mg in the morning, 4 mg in the afternoon, and 8 mg at bedtime after a 2-week titration period. Participants supplied daily reports for alcohol consumption. Generalized linear mixed-effect modeling was used to assess the effect of prazosin compared with placebo on alcohol consumption.

Of the initial cohort, 80 participants completed the titration period and were included in analyses. Researchers identified a significant interaction between study condition and week (P =.01), with number of heavy drinking days decreasing more rapidly in the prazosin group than in the placebo group over the posttitration study course. Similarly, number of drinks per week declined more rapidly in the prazosin group than in the placebo group (P =.03). Specifically, the number of drinks decreased by 8.0 per week (95% CI, 1.8-19.5) for the prazosin group compared with just 1.5 (95% CI, −3.4 to 6.8) for the placebo group. Even so, number of drinks per week at study conclusion did not significantly differ between conditions. A higher number of participants in the prazosin group reported drowsiness and edema, although no other adverse effect differences were observed between conditions.

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These data provide preliminary support for the use of prazosin in the treatment of alcohol use disorder. Study conclusions were limited by high variation in drinking habits across participants and lack of existing knowledge on the optimal dosing of prazosin. Further research is necessary to confirm the potential efficacy of prazosin in reducing consumption among patients with alcohol use disorder.

Disclosures: Dr Saxon is a section editor for UpToDate and has received research support from Medicasafe. Dr Raskind has served on advisory panels for Merck and Takeda. The other authors report no financial relationships with commercial interests.


Simpson TL, Saxon AJ, Stappenbeck C, et al. Double-blind randomized clinical trial of prazosin for alcohol use disorder [published online August 29, 2018]. Am J Psychiatry. doi: 10.1176/appi.ajp.2018.17080913