- Researchers from the National Institutes of Health examined a drug with existing FDA approval to determine whether it works for an alternative purpose.
- Spironolactone is prescribed to treat heart disease. Because the drug is a mineralocorticoid receptor antagonist, researchers were interested to see whether it would provide benefits in treating alcohol use disorders.
- At the end of the study, the group learned that the drug is promising for reducing alcohol consumption.
Sometimes researchers find new uses for existing drugs, which is helpful as they already know potential side effects. A study by the National Institutes of Health (NIH) shows that the heart medication spironolactone may be effective in patients with alcohol use disorders.
While further research is needed on the use of spironolactone for this purpose, the researchers conducted studies with rats, mice, and humans and found that the drug could have benefits. The results were published in Molecular Psychiatry.
Quick facts about alcohol use disorders
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 condition characterized by an impaired ability to stop or stop alcohol use despite adverse social, professional, or health consequences control”.
In the United States, 17 million adults aged 18 and over suffer from an alcohol use disorder, according to the Agency for Healthcare Research and Quality (AHRQ), part of the Department of Health and Human Services.
In addition, according to AHRQ, men are more likely to develop the disorder than women. They predict that 17% of men and 8% of women will develop an alcohol use disorder at some point.
Some people are at higher risk of developing an alcohol use disorder, including people who started drinking before they were 15 years old, people who drink binge drinking, and people with a family history of alcohol abuse or mental health issues.
Some of the characteristics of the disorder include:
- Being unable to stop or reduce drinking
- Getting into situations that may have adverse effects due to alcohol consumption
- Have withdrawal symptoms after alcohol has subsided
- Binge drinking
There are a range of treatments available for people with alcohol use disorders, including therapy and medication. Three FDA-approved drugs for alcohol use disorders include naltrexone, disulfiram, and acamprosate.
One of the main reasons why researchers have investigated spironolactone is that the drug is in the drug class of mineralocorticoid receptor (MR) antagonists.
“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 that aldosterone and MR could contribute to alcohol search and use, the authors were interested in spironolactone as it may be able to reduce this craving.
The researchers conducted three studies that looked at the use of spironolactone to treat alcohol abuse. They conducted studies on rats, mice, and humans.
In the rat study, there were two categories of rats: alcohol-dependent rats and rats without addiction. After both rat categories had been injected with spironolactone, the rats had to press a lever to obtain alcohol.
In the study with mice, the researchers tested spironolactone in mice, which were allowed to consume both sweetened and unsweetened alcohol solutions. The scientists injected spironolactone into the mice before giving them access to the solutions.
In the human cohort study, researchers collected data from the US Department of Veterans on people who were prescribed spironolactone for at least 60 days for one of the approved indications and who reported alcohol consumption themselves. The researchers compared each of these people with up to five people who were not exposed to the drug.
Results of the spironolactone study Both studies in rats and mice showed a
reduced alcohol consumption with spironolactone injections. In addition, the authors found that spironolactone did not impair coordination or movement, nor did they impair their food and water intake.
In the human study, researchers observed a decrease in self-reported alcohol consumption in the group taking spironolactone. Spironolactone had the greatest effect on people who themselves reported excessive alcohol consumption, such as binge drinking.
“These are very encouraging results. Taken together, the present study calls for randomized, controlled trials of spironolactone in people with alcohol use disorder to further assess safety and potential effectiveness in this population, as well as additional work to understand how spironolactone can reduce alcohol consumption.”
— George F. Koob, Ph.D., co-author of the study
Dr. Koob is 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 disorders and spironolactone. Dr. Leggio said they needed “placebo-controlled trials to assess the potential safety and effectiveness of spironolactone in people with alcohol use disorder (AUD).”
Dr. Leggio is a senior investigator in the Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section (CPN), a joint NIDA and NIAAA laboratory.
Suppose scientists continue research on spironolactone and finally submit it for regulatory approval to treat alcohol use disorders. In this case, it could be the fourth FDA-approved medication indicated for this disorder.
Benefits of reusing drugs
This study underlines the importance of continuous research into existing drugs.
“Thanks to advances in biomedical addiction research, we are improving our understanding of the mechanisms that some people develop AUD. Therefore, we can use this knowledge to identify new goals and develop new treatments for AUD.”
— Dr. Leggio
According to the Centers for Disease Control and Prevention (CDC), more than 140,000 people die each year from excessive alcohol consumption. With this in mind, it is highlighted why it is important to focus on reusing existing drugs to treat the disorder and developing new drugs.
“Because this is an old drug that has been used in clinical practice for other indications for decades, by reusing spironolactone, we can quickly move on to the next steps,” commented Dr. Leggio.
Dr. Orman Trent Hall, a board-certified addictionologist and addiction researcher at Ohio State University’s Wexner Medical Center, also spoke to MNT about the study.
“Alcohol consumption is one of the most common causes of death and disability worldwide,” said Dr. Hall. “When people become addicted, they drink in ways that feel out of control and have trouble quitting, even if they find that alcohol is harming them.”
“The search for new drugs for AUD offers hope for a future in which fewer people suffer from the worst consequences of this disorder,” commented Dr. Hall.