From the Guidelines
GLP-1 receptor agonists, such as semaglutide and liraglutide, may be considered for the treatment of alcohol use disorder (AUD) as part of a comprehensive approach, despite not being FDA-approved for this indication, due to their potential to reduce alcohol cravings and consumption through various mechanisms, as suggested by emerging research 1.
Key Considerations
- The use of GLP-1 receptor agonists for AUD is off-label and should be approached with caution, considering the potential benefits and risks, including common side effects like nausea, vomiting, and gastrointestinal distress 1.
- Patients with a history of pancreatitis, medullary thyroid cancer, or multiple endocrine neoplasia syndrome type 2 should avoid these medications due to theoretical risks 1.
- The treatment duration and dosage may follow patterns similar to obesity management, potentially continuing long-term if beneficial, with gradual dose increases as tolerated, starting with lower doses such as 0.25mg weekly for semaglutide 1.
Comprehensive Treatment Approach
- GLP-1 receptor agonists should be used as part of a comprehensive treatment approach, including counseling and support groups, to address the complex nature of AUD 1.
- The emerging nature of this treatment approach should be discussed with patients, emphasizing the need for ongoing monitoring and evaluation of its effectiveness and safety 1.
Evidence and Recommendations
- While the provided evidence does not directly address the use of GLP-1 receptor agonists for AUD, studies suggest their potential benefits in reducing cravings and consumption, as well as their safety profile when used for other indications 1.
- The most recent and highest-quality study, although not directly focused on AUD, supports the use of GLP-1 receptor agonists in reducing cardiovascular risk and improving glycemic control, which may be relevant to patients with AUD and comorbid conditions 1.
From the Research
GLP-1 Agonists for ETOH Dependence
- GLP-1 agonists have been shown to decrease ethanol intake in various studies 2, 3, 4, 5, 6
- The effects of GLP-1 agonists on ethanol intake are thought to be mediated by their ability to modulate reward responses and reduce the motivation to consume alcohol 4, 5
- Long-acting GLP-1 analogs, such as liraglutide and semaglutide, have been found to potently decrease ethanol intake in animal models 2, 6
- GLP-1 receptor agonists have also been shown to reduce alcohol intake in patients with alcohol use disorder (AUD) who have a regular weight or comorbidity of obesity or type 2 diabetes 4
- The central mechanisms by which GLP-1 regulates alcohol-related behaviors are not fully defined, but may involve areas central to reward as well as regions projecting to these reward areas 4
Preclinical and Clinical Evidence
- Preclinical studies have demonstrated that GLP-1 receptor agonists decrease alcohol intake, reduce the motivation to consume alcohol, and prevent relapse drinking 3, 5
- Clinical studies have shown that GLP-1 receptor agonists reduce alcohol intake in patients with AUD 3, 4
- Genetic variations in genes encoding for the GLP-1 receptor are associated with AUD and heavy drinking 4