By Joseph E. Scherger, MD, MPH
Core Faculty, Eisenhower Health Family Medicine Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles
SYNOPSIS: Both animal and human studies suggest spironolactone might be a new agent for helping patients with alcohol use disorder cut their intake.
SOURCE: Farokhnia M, Rentsch CT, Chuong V, et al. Spironolactone as a potential new pharmacotherapy for alcohol use disorder: Convergent evidence from rodent and human studies. Mol Psychiatry 2022; Sep 20. doi: 10.1038/s41380-022-01736-y. [Online ahead of print].
Spironolactone affects the neuroendocrine system as a nonselective mineralocorticoid receptor (MR) antagonist. There is an inverse correlation between alcohol drinking and the expression of MR in the amygdala, a key region in the development of alcohol addiction. Based on evidence suggesting spironolactone produces metabolic effects that could help patients lower alcohol intake, investigators at the National Institute on Drug Abuse studied the effect of the drug in mice and rats. Then, they examined human data from a Veterans Administration (VA) population.
The investigators studied self-reported intake of alcohol among a VA population using the Alcohol Use Disorders Identification-Consumption (AUDIT-C), a tool that helps researchers measure alcohol consumption, using a score scale of 0-12 (scores of 0 reflect no alcohol use). Usually, the higher the AUDIT-C score, the more likely it is the patient’s alcohol drinking is affecting their safety and health.
When VA patients were placed on spironolactone for any reason, there was a dose-related decrease in alcohol consumption. The largest effects were among those who reported heavy alcohol use and were taking 50 mg or more of spironolactone. Closely matched controls not taking spironolactone showed no change in alcohol use over the same period. The authors concluded spironolactone reduces alcohol use and may be a novel new therapy for treating alcohol use disorder.
COMMENTARY
This study reminds me of the fortuitous discovery that patients taking bupropion cut back on smoking, although the drug was under investigation as an antidepressant. Another example was the study of a novel blood pressure agent, minoxidil, which promoted hair growth. Population studies of a new drug may show there are unexpected effects that are not negative, but rather something beneficial. Spironolactone affects the neuroendocrine system — specifically, the amygdala, which is connected to addiction disorders. Our choice of medication for these conditions is limited, so such an addition is welcome. This research may be seen as a major advance for addiction medicine. I plan to start using this drug for alcohol use disorder and possible other addictions.
Both animal and human studies suggest spironolactone might be a new agent for helping patients with alcohol use disorder cut their intake.
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