Claire Wilcox, MD reviewing Haass-Koffler CL et al. Drug Alcohol Depend 2017 Aug.

An alpha-1 noradrenergic antagonist reduces drinking in alcohol-dependent individuals who have high diastolic blood pressure.

Alcohol use disorder (AUD) has significant individual and societal costs. Identifying biomarkers that predict response to medication, thus allowing clinicians to target treatments to specific individuals, would improve outcomes. Although originally developed to reduce blood pressure (BP), alpha-1 antagonists might also reduce alcohol consumption, according to preliminary studies. Higher standing diastolic BP (DBP) has predicted response to this medication class for treatment of post-traumatic stress disorder. DBP may be a surrogate marker of elevated noradrenergic tone, which alpha-1 antagonists reduce. To learn more, researchers reanalyzed data on 41 outpatients with alcohol dependence who had been randomized to doxazosin (titrated to a target dose of 16 mg/day by week 4) or placebo for 10 weeks.

Standing DBP at baseline significantly moderated the effects of doxazosin on drinking levels, in analyses beginning at week 5 and controlling for baseline drinking. Specifically, in individuals with high DBP (>80 mm Hg), doxazosin was associated with significantly fewer drinks per week and heavy drinking days than placebo, with large effect sizes. Individuals with normal DBP demonstrated no medication effects. Moreover, high DBP was associated with greater drinking levels at baseline. Systolic BP was not a moderator.

CITATION(S):

Haass-Koffler CL et al. Higher pretreatment blood pressure is associated with greater alcohol drinking reduction in alcohol-dependent individuals treated with doxazosin. Drug Alcohol Depend 2017 Aug; 177:23.

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