Existing heart medication may help treat alcohol use disorder

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A study found that an FDA-approved medication for cardiovascular conditions, spironolactone, may be repurposed to treat alcohol use disorder. JW LTD/Getty Images
  • Researchers from the National Institutes of Health studied a medication with existing FDA approval to see if it would work for an alternative purpose.
  • Spironolactone is prescribed to treat heart conditions. Because the medication is a mineralocorticoid receptor antagonist, the researchers were interested to see if it would yield benefits in treating alcohol use disorder.
  • By the end of the study, the group learned that the drug shows some promise for decreasing alcohol consumption.

Sometimes researchers find new uses for existing medications, which is helpful since they start from the point of already knowing potential side effects. A study from the National Institutes of Health (NIH) indicates the heart medication spironolactone may be effective for patients with alcohol use disorder.

While more research is necessary on using spironolactone for this purpose, the researchers conducted studies with rats, mice, and humans and saw that the medication might have benefits. The findings were published in Molecular Psychiatry.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a division of the National Institutes of Health (NIH), alcohol use disorder “is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”

In the United States, 17 million adults ages 18 years or older have alcohol use disorder, according to the Agency for Healthcare Research and Quality (AHRQ), part of the Department of Health and Human Services.

Additionally, the AHRQ says men are more likely to develop the disorder than women. They predict that 17% of men and 8% of women will develop alcohol use disorder at some point.

Some people are at a higher risk for developing alcohol use disorder, including people who began drinking before they turned 15, those who binge drink, and those with a family history of alcohol misuse or mental health issues.

Some of the features of the disorder include:

  • Being unable to stop or cut down on drinking
  • Getting into situations that may have harmful effects because of drinking
  • Having withdrawal symptoms after the alcohol wears off
  • Binge drinking

There are a number of treatments for people with alcohol use disorder, including therapy and medications. Three FDA-approved medications for alcohol use disorder are naltrexone, disulfiram, and acamprosate.

One of the main reasons researchers studied spironolactone is because the medication is in the mineralocorticoid receptor (MR) antagonist drug class.

“The steroid hormone aldosterone and its related mineralocorticoid receptor regulate fluid and electrolyte homeostasis,” according to the study authors. Based on preliminary research that suggests aldosterone and MR may contribute to alcohol seeking and consumption, the authors were interested in spironolactone since it can possibly reduce that desire.

The researchers conducted three studies that examined the use of spironolactone to treat alcohol misuse. They conducted studies in rats, mice, and humans.

In the rat study, there were two categories of rats: rats addicted to alcohol and rats with no addiction. After injecting both categories of rats with spironolactone, the rats had to press a lever to receive alcohol.

In the study with mice, the researchers tested spironolactone on mice that were allowed to binge drink both sweetened and unsweetened alcohol solutions. The scientists injected the mice with spironolactone before giving them access to the solutions.

In the human cohort study, the researchers collected data from the U.S. Department of Veterans Affairs on people prescribed spironolactone for any of its approved indications for at least 60 days and who self-reported alcohol consumption. The researchers matched each of these people with up to five individuals not exposed to the drug.

Both rat and mouse studies showed decreased alcohol consumption with the spironolactone injections. Additionally, the authors noted that the spironolactone did not impair coordination or movement, nor did it affect their food and water intake.

In the human study, researchers observed a decrease in their self-reported alcohol consumption in the group that took spironolactone. Spironolactone had the greatest effect on people who self-reported excessive alcohol consumption, such as binge drinking.

“These are very encouraging findings. Taken together, the present study argues for conducting randomized, controlled studies of spironolactone in people with alcohol use disorder to further assess its safety and potential efficacy in this population, as well as additional work to understand how spironolactone may reduce alcohol drinking.”

George F. Koob, Ph.D., co-author of the study

Dr. Koob is the director of the National Institute on Alcohol Abuse and Alcoholism.

Dr. Lorenzo Leggio, a senior co-author of the study, spoke with Medical News Today about the future of research on alcohol use disorder and spironolactone. Dr. Leggio said they need “placebo-controlled studies to assess the potential safety and efficacy of spironolactone in people with alcohol use disorder (AUD).”

Dr. Leggio is the senior investigator in the Clinical Psychoneuroendocrinology and Neuropsychopharmacology (CPN) Section, a joint NIDA and NIAAA laboratory.

Suppose scientists continue the research on spironolactone and eventually submit it for regulatory approval to treat alcohol use disorder. In that case, it could become the fourth FDA-approved medication to be indicated for this disorder.

This study emphasizes the importance of continuing research on existing medications.

“Thanks to the progress in the addiction biomedical research field, we are increasing our understanding of the mechanisms of how some people develop AUD; hence we can use this knowledge to identify new targets and develop new treatments for AUD.”

– Dr. Leggio

According to the Centers for Disease Control and Prevention (CDC), more than 140,000 people die from excessive alcohol consumption each year. With this in mind, it highlights why it is important to focus on repurposing existing medications to treat the disorder and developing new ones.

“Given this is an old medication that has been used for decades in clinical practice for other indications, repurposing spironolactone allows us to move forward quickly to the next steps,” commented Dr. Leggio.

Dr. Orman Trent Hall, a board certified addictionologist and addiction researcher at the Ohio State University Wexner Medical Center, also spoke to MNT about the study.

“Alcohol use is among the leading causes of death and disability in the world,” said Dr. Hall. “When people become addicted, they find themselves drinking in a way that feels out of control and have trouble stopping even after they realize alcohol is harming them.”

“Finding new medications for AUD offers hope for a future when fewer people suffer the worst consequences of this disorder,” commented Dr. Hall.

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