Off-Label Drug May Reduce Alcohol Withdrawal Symptoms

 By Jim Windell

           More than 14 million people in the U.S. have an alcohol abuse disorder. While many try to stop drinking, if they have been drinking over a prolonged period they are likely to experience alcohol withdrawal symptoms when they try to stop their use of alcohol.

           The symptoms of withdrawal can range from moderate to serious – depending on how long the individual has been a heavy drinker. However, the onset of even mild withdrawal symptoms can result in a relapse of drinking. While treatment helps to manage withdrawal symptoms, there is no drug to ease those symptoms that can include anxiety, irritability, insomnia, tremors and even seizures.

           Recent research has investigated whether a drug that was originally developed to treat high blood pressure and prostate problems in men can help people struggling with alcohol addiction. That drug is prazosin and in a double-blind study, researchers gave prazosin or a placebo to 100 people entering outpatient treatment after being diagnosed with alcohol use disorder. Each of those patients had experienced varying degrees of withdrawal symptoms prior to entering treatment.

           The results, published recently by Yale University researchers in the American Journal of Psychiatry, indicated that subjects with more severe symptoms -- including shakes, heightened cravings and anxiety, and difficulty sleeping -- who received prazosin had significantly fewer heavy drinking episodes and fewer days in which they drank compared to those who received a placebo.

           "There has been no treatment readily available for people who experience severe withdrawal symptoms and these are the people at highest risk of relapse and are most likely to end up in hospital emergency rooms," said one of the authors, Rajita Sinha, the Foundations Fund Professor of Psychiatry, a professor of neuroscience, and director of the Yale Stress Center.

           Prazosin, which was originally developed to treat high blood pressure, has shown in previous studies conducted at Yale that the drug works on stress centers in the brain and helps to improve working memory and curb anxiety and craving.

           Sinha's lab has shown that stress centers of the brain are severely disrupted early in recovery, especially for those with withdrawal symptoms and high cravings. This brain disruption though, decreases the longer the person maintains sobriety. The researchers this study, according to Sinha, believe that Prazosin could help bridge that gap by moderating cravings and withdrawal symptoms earlier in recovery while increasing the chances that patients refrain from drinking.

           A drawback, however, is that in its current form prazosin needs to be administered three times daily to be effective.

           To read the journal article, find it at:

            Rajita Sinha, Stephanie Wemm, Nia Fogelman, Verica Milivojevic, Peter M. Morgan, Gustavo A. Angarita, Gretchen Hermes, & Helen C. Fox. (2020). Moderation of Prazosin’s Efficacy by Alcohol Withdrawal Symptoms. American Journal of Psychiatry; appi.ajp.2020.2 DOI: 10.1176/appi.ajp.2020.20050609