Objective: Current medications for alcohol use disorder do not target brain noradrenergic pathways. Theoretical and preclinical evidence suggests that noradrenergic circuits may be involved in alcohol reinforcement and relapse. After a positive pilot study, the authors tested the α-1 adrenergic receptor antagonist prazosin to treat alcohol use disorder in a larger sample.
Method: Ninety-two participants with alcohol use disorder but without posttraumatic stress disorder were randomly assigned to receive prazosin or placebo in a 12-week double-blind study. Medication was titrated to a target dosing schedule of 4 mg in the morning, 4 mg in the afternoon, and 8 mg at bedtime by the end of week 2. The behavioral platform was medical management. Participants provided daily data on alcohol consumption. Generalized linear mixed-effects models were used to examine the impact of prazosin compared with placebo on number of drinks per week, number of drinking days per week, and number of heavy drinking days per week.
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The participant will recognize the potential role of the noradrenergic system in alcohol use disorder and the potential role of noradrenergic medications in treating this disorder.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Duration: 1 hour
Begin Date: December 1, 2018
End Date: November 30, 2020
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Title: Double-Blind Randomized Clinical Trial of Prazosin for Alcohol Use Disorder
Authors: Tracy L. Simpson, Ph.D., Andrew J. Saxon, M.D., Cynthia Stappenbeck, Ph.D., Carol A. Malte, M.S.W., Robert Lyons, Dana Tell, A.R.N.P., Steven P. Millard, Ph.D., Murray Raskind, M.D.
Affiliations: From the Center of Excellence in Substance Abuse Treatment and Education and the Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle (T.L.S., A.J.S., C.A.M., S.P.M., M.R.); the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (T.L.S., A.J.S., C.S., M.R.); and the Seattle Institute for Biomedical and Clinical Research, Seattle (R.L., D.T., S.P.M.).
Disclosures: Dr. Saxon is a section editor for UpToDate, and he 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.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Robert Freedman, M.D. (Editor-in-Chief, AJP); Susan K. Schultz, M.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).
Dr. Schultz has received research support from the Alzheimer’s Disease Cooperative Study for projects conducted in partnership with Toyama Chemical Company and in partnership with Eli Lilly and Company. Dr. Freedman, Mr. Roy, and Mr. Pogachar report no financial relationships with commercial interests.
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