Abstract

Alcohol use disorder (AUD) is a major risk factor for morbidity and mortality worldwide. Three medications are authorized by the U.S. Food and Drug Administration for their management, all of which have limited to moderate efficacy. Prazosin and doxazosin, both alpha1-adrenergic receptor antagonists, appear to be promising candidates for treating AUD. This review will summarize the evidence supporting the efficacy of prazosin and doxazosin in the treatment of AUD. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and conducted searches in PUBMED, Google Scholar, Web of Science, ClinicalTrials. org, and the Cochrane Central Register of Controlled Trials. The analysis included randomized controlled trials of adult patients diagnosed with AUD using the Diagnostic and Statistical Manual-IV criteria. The interventions were prazosin or doxazosin, and the control groups were given a placebo. The primary outcomes evaluated were alcohol consumption (measured in drinks per day or week) and the frequency of heavy drinking days. Six studies were used in the narrative synthesis. The search yielded 416 studies, six of which were included based on already established criteria. Alpha-blockers were found to be safe and had no significant effect on alcohol consumption or cravings. The majority of studies did not report on alcohol abstinence. Prazosin and doxazosin are safe and well-tolerated medications that may help reduce alcohol consumption. However, the observed reductions were not statistically significant in the studies examined. Future research should follow standardized protocols and address the limitations of previous studies.

Key words: Alpha-1 adrenergic blockers, prazosin, doxazosin, alcohol use disorder, systematic review