Heart Medication Shows Potential as Treatment for Alcohol Use Disorder

WASHINGTON – A medication for heart problems and high blood pressure may also be effective for treating alcohol use disorder, according to a new study by researchers at the National Institutes of Health and their colleagues.

The study presents converging evidence from experiments in mice and rats, as well as a cohort study in humans, suggesting that the medication, spironolactone, may play a role in reducing alcohol drinking.

The research was led by scientists at the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, and Yale School of Medicine. 

The findings were published in the journal Molecular Psychiatry.

“Combining findings across three species and different types of research studies, and then seeing similarities in those data, gives us confidence that we are onto something potentially important scientifically and clinically,” said Dr. Lorenzo Leggio, Ph.D., chief of the Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, a joint laboratory of NIDA and NIAAA, in a written statement.

Leggio, one of the senior authors of the study, went on to say the findings support further study of spironolactone as a potential treatment for alcohol use disorder, a medical condition that affects millions of people in the U.S.

Currently there are three medications approved for alcohol use disorder in the United States. But given the diverse biological processes that contribute to alcohol use disorder, new medications are needed to provide a broader spectrum of treatment options. 

Previous research has shown that mineralocorticoid receptors, which are located throughout the brain and other organs and help regulate fluid and electrolyte balance in the body, might play a role in alcohol use and craving.

Preclinical research suggests that higher mineralocorticoid receptor signaling contributes to increased alcohol consumption.

The current study sought to expand this line of research by testing spironolactone, a medication with multiple actions, including blocking mineralocorticoid receptors. Spironolactone is used in clinical practice as a diuretic and to treat conditions like heart problems and high blood pressure.

In experiments conducted in mouse and rat models of excessive alcohol drinking, NIAAA and NIDA researchers led by co-senior author Leandro Vendruscolo, Pharm.D., Ph.D., from NIDA found that increasing doses of spironolactone decreased alcohol consumption in male and female animals, without causing movement or coordination problems, and without affecting their food or water intake.

In a parallel study, researchers led by co-senior author Amy C. Justice, M.D., Ph.D., of the Yale School of Medicine, examined health records of a large sample of people from the U.S. Veterans Affairs health care system to assess potential changes in alcohol drinking after spironolactone was prescribed for its current clinical indications (for example, heart problems, high blood pressure).

They found a significant association between spironolactone treatment and reduction in self-reported alcohol consumption, as measured by the Alcohol Use Disorders Identification Test-Consumption, a screening tool. 

Of note, the largest effects were observed among those who reported hazardous/heavy episodic alcohol consumption before starting spironolactone treatment.

“These are very encouraging findings,” said NIAAA Director George F. Koob, Ph.D., a co-author of the study, in a written statement. 

“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,” Koob said.

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