A medication already safe for millions may offer hope to those with few options
A medication long trusted to ease the burden of failing hearts may now offer something to those struggling with a different kind of weight. Spironolactone, a diuretic in use since the late 1950s, has shown in both animal studies and Veterans Affairs patient records that it may meaningfully reduce alcohol cravings and consumption — particularly among the heaviest drinkers. The finding arrives at a moment when only two medications are considered reliably effective for a condition that quietly affects 14.5 million Americans, most of whom never receive any treatment at all. Science, it seems, sometimes finds new answers in old medicine.
- Millions of Americans live with alcohol use disorder while the treatment options available to them remain stubbornly thin — only two approved medications are considered truly effective.
- A decades-old heart drug, spironolactone, has surfaced as an unexpected candidate, reducing alcohol consumption in both dependent rodents and real-world VA patients without alarming side effects.
- The effect was sharpest among the heaviest drinkers and those on the highest doses, giving researchers a signal strong enough to take seriously.
- Despite the promising dual-track evidence — controlled animal studies and large-scale patient records — no clinical approval is imminent; researchers are calling for randomized controlled trials to confirm what the data suggests.
- The path forward is one of cautious momentum: drug repurposing offers a faster route than starting from scratch, and for those currently without options, that speed could matter enormously.
A medication that has spent decades treating heart failure and high blood pressure may have quietly discovered a second calling. Spironolactone, a steroid-based diuretic developed in the late 1950s, shows early promise in reducing both the craving for and consumption of alcohol, according to new research from the National Institutes of Health published in Molecular Psychiatry.
The investigation unfolded in two stages. First, researchers gave spironolactone to alcohol-dependent mice and rats, finding that as doses increased, both male and female animals drank less — without losing their appetite for food or water, and without other troubling side effects. Encouraged, the team then turned to Veterans Affairs medical records and compared patients already taking spironolactone for unrelated conditions against matched patients who were not. Those on the drug reported significantly reduced alcohol consumption, with the strongest effects seen among the heaviest drinkers and those on the highest doses.
The findings land against a stark backdrop. Alcohol use disorder affects an estimated 14.5 million Americans, yet fewer than one in ten receive treatment in any given year. Of the three medications currently approved for the condition, only naltrexone and acamprosate are considered reliably effective; the third, disulfiram, is largely a last resort.
George Koob, director of the National Institute on Alcohol Abuse and Alcoholism and a co-author of the study, called the results encouraging while stressing that randomized controlled trials in human patients are needed before any new approval could be considered. The research represents a classic case of drug repurposing — leveraging an already-approved medication's safety profile to accelerate the search for new treatments. Whether spironolactone can translate its promise from patient records and rodent studies into a reliable clinical option remains the question the next phase of research will have to answer.
A medication that has spent decades in medicine cabinets treating heart failure and high blood pressure may have found a new purpose. Spironolactone, a steroid-based diuretic discovered in the late 1950s, shows promise in reducing both the craving for and actual consumption of alcohol, according to research released this week by the National Institutes of Health. The finding emerges from a two-part investigation that examined the drug's effects first in laboratory animals, then in real patient records, suggesting a path toward a much-needed new treatment for a condition that affects millions.
Spironolactone works by blocking certain hormones and inducing the body to shed water and sodium through increased urination. Doctors have long prescribed it to manage fluid buildup in heart failure and kidney disease, and sometimes to control high blood pressure when combined with other medications. Over time, clinicians noticed the drug had other applications—it can suppress androgen hormones that drive excess oil production, making it useful for treating acne in women, though men experience testosterone suppression that limits its usefulness in that context. Recent research suggested that the same receptors spironolactone inhibits might also influence how much alcohol a person drinks, opening a new avenue of investigation.
To test this theory, NIH researchers studied mice and rats that had been made dependent on alcohol or intoxicated. As they increased spironolactone doses, both male and female rodents drank less alcohol. Importantly, the animals showed no compensatory behaviors—they didn't lose their appetite for food and water or exhibit other troubling side effects. The results were consistent enough to warrant the next step: examining whether the pattern held in human patients.
The researchers turned to Veterans Affairs medical records, the nation's largest integrated health care system, and compared patients taking spironolactone for other conditions against matched controls who were not on the drug. Those taking spironolactone reported significantly reduced alcohol consumption afterward. The effect was strongest among people who had been the heaviest drinkers before starting the medication and among those who took the highest doses. These parallel findings—one from controlled animal studies, one from real-world patient data—created what the authors describe as a compelling case for further investigation.
The timing matters. Alcohol use disorder is a chronic condition that affects an estimated 14.5 million Americans, yet fewer than one in ten people struggling with it receive any treatment in a given year. Only three medications are currently approved to address the condition, and just two of those—naltrexone and acamprosate—are considered reliably effective as first-line treatments. The third, disulfiram, causes unpleasant symptoms like nausea when someone drinks and is typically reserved for last-resort situations. The treatment landscape is thin for a condition that carries such human weight.
George Koob, director of the National Institute on Alcohol Abuse and Alcoholism and an author of the study published Tuesday in Molecular Psychiatry, called the findings encouraging. He emphasized that while the evidence is not yet definitive enough to approve spironolactone as a new alcohol disorder treatment, it makes a strong case for moving forward with randomized controlled trials in human patients. Those studies would need to confirm both the drug's safety and its actual effectiveness in people diagnosed with alcohol use disorder, as well as clarify the biological mechanism by which spironolactone appears to reduce drinking.
The research represents a form of drug repurposing—taking a medication already approved for one condition and investigating whether it might help with another. It's an efficient approach when the preliminary evidence is solid, as it can accelerate the path to new treatment options. For the millions of Americans struggling with alcohol dependence and the far smaller number who currently have access to effective medications, the prospect of another tool in the treatment arsenal could matter considerably. The next phase will determine whether what works in rodents and appears in patient records can translate into a reliable, safe treatment option for people seeking help.
Notable Quotes
These are very encouraging findings. The study argues for conducting randomised, controlled studies of spironolactone in people with alcohol use disorder to further assess its safety and potential efficacy.— George Koob, director of the National Institute on Alcohol Abuse and Alcoholism
The Hearth Conversation Another angle on the story
Why does a heart drug matter for alcohol addiction? They seem unrelated.
They're not as separate as they seem. Spironolactone blocks certain hormone receptors in the brain, and it turns out those same receptors influence how much someone wants to drink. The drug was already safe enough for millions of people to take daily—that's a huge advantage.
So this is just about finding new uses for old drugs?
It's more than that. We have very few medications that actually work for alcohol use disorder. Only two are considered reliable, and they don't work for everyone. When you have 14.5 million people struggling and fewer than one in ten getting any treatment, you need more options.
The animal studies showed it worked, but does that mean it will work in people?
That's exactly what they need to test next. The VA records are encouraging—patients on spironolactone did drink less—but those aren't controlled trials. You need to give some people the drug and others a placebo, carefully track what happens, and rule out other explanations.
What if it doesn't work in larger trials?
Then they'll have learned something valuable about how the brain responds to this particular drug. But the fact that both the animal data and the patient records point the same direction is what makes researchers think it's worth the time and money to find out.