A Common Heart Drug May Help People Struggling with Alcohol Use Disorder

A common heart and blood pressure drug could see a second act as a treatment for alcohol use disorder, new government-led research this week suggests. The study has found evidence in both rodents and humans that the medication spironolactone can reduce people’s craving for and consumption of alcohol.

Spironolactone has been in the medicine cabinet for decades, having first been discovered in the late 1950s. It’s a type of steroid primarily used for its diuretic effect, meaning that it induces the loss of water and sodium through increased urine production. It’s long been used to reduce fluid build-up brought on by conditions like heart failure and kidney disease, lowering the risk of later serious complications; it’s also used in combination with other drugs to reduce high blood pressure.

Over the years, it’s become apparent that spironolactone is useful for other health problems beyond these indications. Because it can block the production of androgen hormones linked to excess oil production, for instance, 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 started to show that the receptors inhibited by spironolactone may also play a role in driving people’s consumption of alcohol. If that’s the case, then 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 that were made to become inebriated or dependent on alcohol. They found that increasing doses of spironolactone led to corresponding lower levels of alcohol consumption among both kinds of rodents, male and female, and without possible adverse effects like a reduced appetite for food and water.

A second part of the research analyzed the medical records of patients treated through Veterans Affairs, the country’s largest integrated health care system. Compared to similarly matched control patients who weren’t taking the drug, VA patients on spironolactone for other conditions reported greater reduced alcohol use afterward. And this reduction was largest in people who reported the highest levels of alcohol use before going on the drug, as well as in people who took the highest doses of spironolactone.

These findings, published Tuesday in the journal Molecular Psychiatry, aren’t the sort of definitive proof needed to approve spironolactone as a new treatment for alcohol use disorder. But the different lines of evidence make a strong case that it’s now worth spending the time and resources to find out for sure, the authors say.

“These are very encouraging findings,” said study author George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, in a statement from the NIH. “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.”

There are three approved medications for alcohol use disorder. Only two of these drugs, naltrexone and acamprosate, are considered effective front-line treatments (the third drug, disulfiram, causes symptoms like nausea when a person tries to drink and is usually only recommended as a last resort). So, more treatments are certainly needed for this difficult-to-manage condition. It’s 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. But less than 10% of sufferers have received any treatment in the past year, according to the National Institute on Alcohol Abuse and Alcoholism.