There are currently three FDA-approved medications for treating alcohol use disorder (AUD), along with several off-label options. But medications aren’t one-size-fits-all, and even medications that work for many people do not work for every person. Like people with other health conditions, people with AUD need a range of medication options.
That’s why researchers are working to discover more medications that are effective for treating alcohol dependence. Recently, a study from the National Institute of Health found that the heart medication spironolactone shows promise for treating AUD.1
In this post, we’ll share everything we know so far about spironolactone, what we still need to know, and how to determine which medication for AUD is right for you.
What Is Spironolactone?
Spironolactone is a prescription medication used to treat build-up of fluid in the body caused by conditions like liver disease and nephrotic syndrome (a kidney problem). It can also be used to treat heart failure and high blood pressure. It’s available as an oral tablet or an oral suspension, either as a generic drug or as the brand-name drug Aldactone.
A potassium-sparing diuretic, spironolactone works by blocking aldosterone activity. Aldosterone is a chemical made by the body that can cause water retention, making certain liver, kidney, and heart conditions worse. When aldosterone is blocked, your body won’t retain excess fluid, and potassium won’t be excreted by your body. By blocking aldosterone’s effect on your blood vessels, spironolactone may lower your blood pressure.
Side effects of spironolactone may include drowsiness, leg cramps, high potassium levels, nausea and vomiting, and headache. It shouldn’t be taken with certain pain medications or with drugs that increase the amount of potassium in your body.2
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How Does Spironolactone Work For Alcohol Use Disorder?
Spironolactone is not yet approved by the Food and Drug Administration (FDA) to treat alcohol use disorder (AUD) specifically. But it has been studied as a potential AUD treatment and has shown promise in reducing alcohol cravings and the risk of relapse.
Researchers decided to study spironolactone for AUD because the medication is in the mineralocorticoid receptor (MR) antagonist drug class. Studies suggest that MR and aldosterone may contribute to seeking and consuming alcohol, so researchers were interested in spironolactone’s potential to reduce that desire.3
Studies by the National Institute of Health (NIH) with rats, mice, and humans found that taking spironolactone helped participants reduce their drinking. In the human study, the medication had the greatest effect on people who had self-reported excessive drinking, such as binge drinking. The study’s authors noted that while the results were encouraging, more research is needed to confirm these findings.4
How Effective Is Spironolactone For AUD?
Initial research on spironolactone as a treatment for AUD shows potential. In the NIH rodent studies, for example, rats and mice addicted to alcohol and injected with spironolactone reduced their alcohol consumption. The medication did not cause any issues with movement, coordination, or food and water intake.
For the human cohort study, researchers collected data from the U.S. Department of Veterans Affairs on people prescribed spironolactone who also self-reported alcohol consumption. Each of these individuals were matched with up to five people not exposed to the medication. In the group that took spironolactone, researchers observed a decrease in self-reported alcohol consumption, especially among those who reported excessive drinking at the start of the study.5
A similar cohort study measured whether people who were prescribed spironolactone reported any changes in weekly alcohol use about six months later, in comparison to untreated adults. The treated patients reduced weekly alcohol use by 3.5 drinks, while untreated patients reduced consumption by 2.74 drinks. Treated patients who reported more than seven drinks at baseline reduced their drinking even more—by an average of 4.18 drinks.6
Overall, spironolactone appears promising for treating AUD, especially for those who drink heavily. But more research is needed to determine its safety and effectiveness, and to determine the optimal dosage and duration for treatment.
Should I Try Spironolactone For AUD?
If you’re struggling with AUD, it’s important to speak to a healthcare provider or a substance abuse specialist to find the most appropriate treatment for your specific needs.
Medication is most effective in combination with other forms of support like group meetings, recovery coaching, or regular therapy sessions. And the best medication for you depends on factors like your current pattern of alcohol use, overall goals, health history, and related medical needs. The right combination of medication and support can help you establish lasting change.
Research on spironolactone for alcohol dependence is still in the early stages, but medications that are already commonly used for AUD include:
- Naltrexone: By blocking the pleasurable effects of alcohol, naltrexone helps limit alcohol cravings. It has a high success rate and can help people with AUD learn to drink in moderation
- Disulfiram/Antabuse: The original medication for treating AUD, disulfiram makes you feel ill when you drink, motivating you to establish new habits and stay abstinent. Gentler medications are now available, but antabuse can work well for some people..
- Acamprosate: Acamprosate works by restoring the chemical imbalance in the brain caused by alcohol dependence. It’s typically used to help people maintain sobriety after they’ve stopped drinking.
- Baclofen: Initially approved to treat muscle spasms, baclofen can reduce binge drinking and relapse by helping control alcohol cravings.
- Topiramate: Although it’s typically used to treat migraines and seizures, topiramate has shown strong effectiveness for limiting alcohol cravings, improving anxiety-related drinking, reducing overall consumption, and treating physical addiction symptoms.
- Gabapentin: For people who struggle with anxiety and insomnia, the epilepsy drug gabapentin can be especially effective for treating AUD. It can help ease withdrawal symptoms, reduce alcohol consumption, and smoothly transition to other medications.
If you’re interested in medication-assisted treatment for AUD, Ria Health is here for you. Our expert team will develop a customized treatment plan based on your individual needs, including prescribing the medication that’s best for you.
We use technology, medication for alcoholism, and online coaching to help you cut back or quit drinking from home. Learn more about how it works, or get in touch with a compassionate member of our team today.