title: A pilot trial of prazosin, an alpha-1 adrenergic antagonist, for comorbid alcohol dependence and posttraumatic stress disorder.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) commonly co-occur and are associated with greater symptom severity and costs than either disorder alone. No pharmacologic interventions have been found to decrease both alcohol use and PTSD symptom severity relative to matched placebo. Prazosin, an alpha-1 adrenoreceptor antagonist, has demonstrated the efficacy of reducing PTSD and AD symptoms among individuals with one or the other disorder and may be useful in addressing comorbid PTSD/AD.
  
  
  METHODS
  Prazosin and matched placebo were compared in the context of an outpatient 6-week double-blind randomized controlled pilot trial involving 30 individuals with comorbid PTSD/AD. Medication was titrated to 4 mg q am, 4 mg q pm and 8 mg qhs by the end of week 2. Participants in both conditions received 5 medical management sessions. Information regarding alcohol use, craving, and PTSD was gathered daily using a telephone interactive voice response system.
  
  
  RESULTS
  Participants randomized to prazosin had a greater reduction in percent days drinking per week and percent days heavy drinking per week between baseline and week 6 than did placebo participants. No significant differences were detected within or between groups in change from weeks 1 to 6 in total PTSD symptoms. Participants in the prazosin condition reported drowsiness on significantly more days than those in the placebo condition.
  
  
  CONCLUSIONS
  Consistent with the extant research evaluating medications for comorbid PTSD/AD, the current evaluation of prazosin also found decreased alcohol consumption but no medication effect on PTSD symptomatology.
authors.affiliation: Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington; Mental Illness Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Simpson
authors.forename: Carol A
authors.initials: CA
authors.lastname: Malte
authors.forename: Bergetta
authors.initials: B
authors.lastname: Dietel
authors.forename: Dana
authors.initials: D
authors.lastname: Tell
authors.forename: Ian
authors.initials: I
authors.lastname: Pocock
authors.forename: Robert
authors.initials: R
authors.lastname: Lyons
authors.forename: Dana
authors.initials: D
authors.lastname: Varon
authors.forename: Murray
authors.initials: M
authors.lastname: Raskind
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000188:drug therapy*; D066249:Craving / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011224:Prazosin / Q000009:adverse effects / Q000627:therapeutic use*; D012894:Sleep Stages / Q000187:drug effects; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011224:Prazosin
keywords: Alcohol Dependence; Human Clinical Trial; Noradrenergic; Posttraumatic Stress Disorder; Prazosin
references.citation: J Neurosci. 2000 May 1;20(9):3157-64
references.pmid: 10777779
references.citation: Addict Behav. 2014 Feb;39(2):428-33
references.pmid: 24035645
references.citation: Eur J Pharmacol. 2002 Jul 19;448(2-3):151-6
references.pmid: 12144935
references.citation: J Neurosci. 2003 Mar 1;23(5):1879-85
references.pmid: 12629192
references.citation: Alcohol Alcohol. 2003 May-Jun;38(3):224-31
references.pmid: 12711656
references.citation: Clin Pharmacokinet. 1980 Jul-Aug;5(4):365-76
references.pmid: 6994981
references.citation: Arch Neurol. 1981 May;38(5):289-92
references.pmid: 7224914
references.citation: J Trauma Stress. 1995 Jan;8(1):75-90
references.pmid: 7712061
references.citation: J Stud Alcohol Suppl. 1994 Dec;12:112-8
references.pmid: 7722987
references.citation: Alcohol Clin Exp Res. 1999 Aug;23(8):1289-95
references.pmid: 10470970
references.citation: Alcohol Clin Exp Res. 2005 Mar;29(3):395-401
references.pmid: 15770115
references.citation: JAMA. 2005 Apr 6;293(13):1617-25
references.pmid: 15811981
references.citation: JAMA. 2006 May 3;295(17):2003-17
references.pmid: 16670409
references.citation: Biol Psychiatry. 2006 Oct 1;60(7):777-83
references.pmid: 17008146
references.citation: Neuroreport. 2006 Nov 27;17(17):1813-7
references.pmid: 17164670
references.citation: Biol Psychiatry. 2007 Apr 15;61(8):928-34
references.pmid: 17069768
references.citation: Arch Gen Psychiatry. 2007 Sep;64(9):1069-77
references.pmid: 17768272
references.citation: Biol Psychiatry. 2008 Mar 15;63(6):629-32
references.pmid: 17868655
references.citation: Depress Anxiety. 2008;25(3):260-71
references.pmid: 17354267
references.citation: Alcohol Clin Exp Res. 2009 Feb;33(2):255-63
references.pmid: 18945226
references.citation: Alcohol Clin Exp Res. 2009 Feb;33(2):264-72
references.pmid: 19032582
references.citation: Neuropsychopharmacology. 2012 Aug;37(9):2161-72
references.pmid: 22588352
references.citation: Hum Psychopharmacol. 2011 Jan;26(1):4-11
references.pmid: 21308782
references.citation: J Abnorm Psychol. 2014 Feb;123(1):237-47
references.pmid: 24661174
references.citation: Alcohol Clin Exp Res. 2014 Aug;38(8):2169-77
references.pmid: 25092377
references.citation: Behav Res Ther. 2015 Mar;66:8-17
references.pmid: 25617814
references.citation: Brain Res. 2009 Oct 13;1293:61-75
references.pmid: 19332030
references.citation: Clin Psychol Rev. 2009 Dec;29(8):715-26
references.pmid: 19800725
references.citation: CNS Drugs. 2010 Dec;24(12):997-1007
references.pmid: 21090836
references.citation: J Subst Abuse Treat. 2011 Sep;41(2):186-92
references.pmid: 21546205
references.citation: Psychopharmacology (Berl). 2011 Nov;218(1):89-99
references.pmid: 21318567
references.citation: Neuropharmacology. 2012 Feb;62(2):542-51
references.pmid: 21600225
references.citation: J Psychosom Res. 2012 Feb;72(2):89-96
references.pmid: 22281448
references.citation: Alcohol Clin Exp Res. 2012 Feb;36(2):351-60
references.pmid: 21919922
references.citation: Neuropsychopharmacology. 2012 Mar;37(4):996-1004
references.pmid: 22089316
references.citation: Am J Psychiatry. 2001 Aug;158(8):1184-90
references.pmid: 11481147
references.citation: CNS Drugs. 2013 Mar;27(3):221-32
references.pmid: 23483368
references.citation: JAMA. 2013 Aug 7;310(5):488-95
references.pmid: 23925619
references.citation: Drug Alcohol Depend. 2013 Oct 1;132(3):630-8
references.pmid: 23702490
references.citation: Am J Psychiatry. 2013 Sep;170(9):1003-10
references.pmid: 23846759
references.citation: JAMA Psychiatry. 2013 Nov;70(11):1199-205
references.pmid: 24048210
references.citation: Alcohol. 2012 Jun;46(4):303-8
references.pmid: 22449787