Cyproheptadine-prazosin combo can reduce drinking in people with alcohol use disorder: Study

A recent study published in the Addiction journal unveiled promising results for treating severe alcohol use disorder (AUD) using a combination of two medications, prazosin and cyproheptadine. This approach targets the α1b and 5HT2A receptors which demonstrated a significant reduction in alcohol consumption among participants.

This phase 2, double-blind, placebo-controlled study was conducted across 32 addiction treatment centers in France and involved a total of 154 participants who were diagnosed with severe AUD. This diverse group included 108 men and 46 women who were all rigorously selected to partake in this research.

The participants were divided into three groups for the three-month treatment duration. The low-dose group (LDG) received 8 mg of cyproheptadine and 5 mg of prazosin in extended-release form daily, while the high-dose group (HDG) was administered 12 mg of cyproheptadine and 10 mg prazosin daily. The control group received a placebo. The primary objective was to observe the change in total alcohol consumption (TAC) from the outset of the trial to the end of the three months.

The results found that both the LDG and HDG showed a significant decrease in TAC when compared to the placebo group, with the HDG demonstrating the most pronounced reduction. The HDG reduced their daily alcohol intake by an impressive 23.6 grams, while the LDG saw a reduction of 18.4 grams. These results were statistically significant and suggest that increased doses of the medication combination may lead to greater reductions in alcohol consumption. The subgroup of participants with very high-risk drinking levels (over 100 grams per day for men and over 60 grams per day for women) found the HDG to show an even more significant decrease in daily drinking by 29.8 grams.

Both medication doses were reported to be well-tolerated by participants by displaying similar safety profiles which are crucial for the treatment of chronic conditions such as AUD. This favorable safety profile combined with the efficacy of the treatment, marks a major step towards the management of alcohol dependence. Overall, these findings provide hope for the individuals with severe alcohol use disorder and contribute to the understanding of the complex neurobiology of addiction.

Source:

Aubin, H., Berlin, I., Guiraud, J., Bruhwyler, J., Batel, P., Perney, P., Trojak, B., Bendimerad, P., Guillou, M., Bisch, M., Grall‐Bronnec, M., Labarrière, D., Delsart, D., Questel, F., Moirand, R., Bernard, P., Trovero, F., Pham, H. P., Tassin, J., & Puech, A. (2024). Prazosin and cyproheptadine in combination in the treatment of alcohol use disorder: A randomized, double‐blind, placebo‐controlled trial. In Addiction. Wiley. https://doi.org/10.1111/add.16484