Role of prazosin in patients with Guillain–Barré syndrome with sympathetic overactivity: A cohort study

Abstract

AbstractIntroduction/AimsIn Guillain–Barré syndrome (GBS), patients with dysautonomia demonstrate sympathetic overactivity (SO). This study assessed the role of prazosin (α1‐blocker) in the management of SO.MethodsThis cohort study was conducted from January 2022 to September 2023. Thirty‐two GBS patients with SO received prazosin (2.5–10 mg three times a day) (prazosin group). For comparison, we included historical controls that included 33 GBS patients having SO with similar baseline characteristics, including median age and disability, who did not receive prazosin, from a GBS registry of patients admitted during February 2018–December 2021. The primary endpoint was days to resolution of SO. Secondary endpoints were daily fluctuations in the systolic (SBP) and diastolic blood pressure (DBP), duration of hospital stay, in‐hospital mortality, and disability at 3 months.ResultsThe median ages of both the treatment and the control groups were 36 (IQR 25–49) years and 43 (66.2%) were males. The demographic and clinical parameters were comparable. Prazosin resulted in significantly earlier normalization of SO compared to the control group (median 15 vs. 20 days; p = .01). The mean fluctuations in the SBP and DBP at 15 days were significantly lower in the prazosin group. However, the duration of hospital stay and good recovery at 3 months were comparable. Three patients developed hypotension, while two patients died (ventilator‐associated pneumonia) in the prazosin group.DiscussionThis study provides new evidence supporting the role of prazosin in SO, and needs randomized trials to confirm our findings.