Ruud romped through the opening set before fighting back from 5-2 behind in the second to win 6-1, 7-5 in Turin.
World number three Alcaraz made 34 unforced errors in an uncharacteristically errant display. It was Ruud's first victory over Alcaraz in their five career meetings.
"I had two good times in Turin before... This part of the season has not been good for me but hopefully I've saved some wins for this week and I've started well," said Ruud.
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