Heart drug shows potential as treatment for alcohol use disorder – ScienceDaily

A new study by researchers at the National Institutes of Health and their colleagues shows that a drug for heart problems and high blood pressure may also be effective in treating alcohol use disorder. The study provides converging evidence from experiments in mice and rats, as well as a cohort study in humans, that spironolactone may play a role in reducing alcohol drinking. The research was led by scientists at the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), both from the National Institutes of Health, and Yale University School of Medicine, New Haven, Connecticut. The new findings report has been published in Molecular Psychiatry.

“Combining the results across three different types and types of research studies, and then seeing the similarities in that data, gives us confidence that we are looking at something potentially of scientific and clinical interest. These findings support further study of spironolactone as a potential treatment for alcohol use disorder, which is a condition medical conditions affecting millions of people in the United States,” said Lorenzo Leggio, MD, PhD, chair of the division of clinical endocrinology and neuropsychology, a joint NIDA-NIAAA laboratory, and one of the senior authors.

There are currently three medications approved for alcohol use disorder in the United States, and they are an effective and important aid in treating people with this condition. Given the diverse biological processes that contribute to alcohol use disorder, new drugs are needed to provide a broader range of treatment options. Scientists are working to develop a larger list of pharmaceutical treatments that can be tailored to individual needs.

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, may play a role in alcohol abuse and craving. Preclinical research indicates that elevated mineralocorticoid receptor signaling contributes to increased alcohol consumption. The current study sought to extend this research by testing spironolactone, a drug with multiple actions, including blocking mineralocorticoid receptors. Spironolactone is used in clinical practice as a diuretic and to treat conditions such as heart problems and high blood pressure.

In experiments using mouse and rat models of excessive drinking, NIAAA and NIDA researchers led by co-senior author Leandro Vendruscolo, MD, PhD, of NIDA found that increased doses of spironolactone reduced alcohol consumption in males and females. Female animals, without causing problems with movement or coordination, and without affecting their food or water intake.

In a parallel study that was part of this team’s collaborative effort, researchers led by co-lead author Amy C. Justice, MD, PhD, of Yale University School of Medicine, examined the health records of a large sample of people from the United States Veterans Affairs health care system. To evaluate potential changes in drinking alcohol after spironolactone is prescribed for its current clinical indications (eg, heart problems, high blood pressure). They found a significant association between spironolactone treatment and reduced self-reported alcohol consumption, as measured by the Alcohol Use Disorders Identification Test, a screening tool. Of note, the largest effects were observed among those who reported serious alcohol use/heavy seizures before starting treatment with spironolactone.

NIAAA Director George F. Cobb, co-author of the study: “These are very encouraging results.” Taken together, the current study argues for randomized controlled studies of spironolactone in people with alcohol use disorder to assess its potential safety and efficacy in this population, as well as additional work to understand how spironolactone may reduce alcohol drinking.

“Just like any other medical condition, people with substance use disorders deserve to have the range of treatment options available to them, and this study is an exciting step in our efforts to expand the range of medications for people with alcohol use disorder,” said Nora Volkow. MD, director of the NIDA. “In addition, we must address the stigma and other barriers that prevent many people with alcohol use disorder from accessing the treatments we already have.”