A joint heart and blood pressure drug could be used as a second measure to treat alcohol use disorders, new government-led research suggests this week. The study found evidence in both rodents and humans that the drug spironolactone can reduce alcohol cravings and consumption.
Spironolactone has been in the medicine cabinet for decades since it was first discovered in the late 1950s. It is a type of steroid used primarily for its diuretic effects, meaning that it induces the loss of water and sodium through increased urine production. It has long been used to reduce fluid build-up caused by conditions such as heart failure and kidney disease, reducing the risk of serious complications later on. It is also used in combination with other medications to lower high blood pressure.
Over the years, spironolactone has been found to be useful for other health issues beyond these indications. For example, because it can block the production of androgen hormones associated with excess oil production, it’s sometimes used to treat acne in women (in men, it causes low testosterone levels that aren’t worth the side effects). And some research has begun to show that the receptors inhibited by spironolactone may also play a role in promoting alcohol consumption. If so, the drug could help people suffering from alcohol use disorder — a chronic condition with few treatments.
To better understand the drug’s potential, researchers at the National Institutes of Health decided to study its effects on mice and rats tricked into getting drunk or addicted to alcohol. They found that increasing spironolactone doses resulted in correspondingly lower alcohol consumption in both species of rodents, males and females, with no potential side effects such as decreased appetite for food and water.
A second part of the research analyzed the medical records of patients treated by Veterans Affairs, the country’s largest integrated healthcare system. Compared to similarly matched controls not taking the drug, VA patients taking spironolactone for other conditions reported greater reductions in alcohol consumption afterwards. And this reduction was greatest among people who reported the highest alcohol consumption before taking the drug and among people taking the highest doses of spironolactone.
These findings, published Tuesday in the journal Molecular Psychiatry, are not the kind of definitive evidence needed to approve spironolactone as a new treatment for alcohol use disorder. But the divergent lines of evidence suggest it’s now worth investing the time and resources to find out for sure, say the authors.
“These are very encouraging results,” study author George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, said in a statement from the NIH. “Overall, the present study advocates conducting randomized, controlled trials of spironolactone in people with alcohol use disorder to further evaluate its safety and potential efficacy in this population, and additional work to understand how spironolactone may reduce alcohol consumption.”
There are three approved medications for alcohol use disorders. Only two of these drugs, naltrexone and acamprosate, are considered effective first-line treatments (the third drug, disulfiram, causes symptoms such as nausea when a person tries to drink and is usually only recommended as a last resort). Therefore, more treatments are certainly needed for this difficult-to-treat condition. It is estimated that 14.5 million Americans struggle with alcohol use disorder, defined as a chronic physical and emotional dependence on alcohol that harms themselves and others. However, less than 10% of those affected have received treatment in the past year, according to the National Institute on Alcohol Abuse and Alcoholism.
Editor’s note: The release dates in this article are for the US, but will be updated with local Australian dates once we know more.