Semaglutide (Ozempic, Wegovy) and other drugs in its class are widely known for their role in the management of type 2 diabetes and appetite suppression. Studies show that they may one day also prove useful in curbing certain addictive behaviors such as alcohol consumption and smoking.
Preclinical studies have shown promising results, with endocrinologists and patients anecdotally reporting reduced cravings for alcohol. shopping, and even coffee.
“The one thing we hear consistently from all patient groups is that they’re in control,” said Gitanjali Srivastava, M.D., an internist and director of the Obesity Medicine Program at Vanderbilt University Medical Center in Nashville. “I used to lose control.” , Tennessee told MedPage Today. “Suddenly there is stillness. It’s like the calmness after a storm.”
Srivastava said that not only did patients eat less, which had previously been out of control, but a variety of other behaviors after they started taking the drug made them feel like their “valves were shut.” said he felt “Suddenly, they can step back and say, ‘Oh, the gambling, addiction, alcoholism, shopping phenomenon was going on, and all of a sudden it stopped.'”
However, the precise mechanisms behind the effects of semaglutide and other GLP-1 agonists on behaviors such as smoking and drinking are poorly understood.Researchers are in the early stages learning how to use Experts said unresolved questions about semaglutide’s potential addictive indications need to be brought to the attention and caution of prescribers.
Semaglutide modulates the release of insulin through the pancreas, thereby helping blood sugar control in patients with type 2 diabetes. However, it also acts in the brain via GLP-1.
“If you look at where the GLP-1 receptor is located in the brain, you can see that the GLP-1 receptor is really widely distributed. It is thought to be in many nuclei of the brain centers associated with ,” says Daniel Drucker, MD. Drs from the Lunenfeld Tanenbaum Institute at Mount Sinai Hospital in Toronto told MedPage Today.
“The challenge we have is that there are anecdotal reports and they are fairly widespread. We have a lot of clinicians reporting this and they are reporting experiences on social media What we don’t have is a definitive randomized controlled clinical trial,” he said. Added.
Years of animal studies have shown similar responses to other GLP-1 agonists, including: Liraglutide (Saxenda)inhibited or decreased alcohol intake in rats, african vervet monkey.Exenatide (Byetta) and Opioid-related action had different resultsbut reduce nicotine uptake in mice.
Drucker said the mechanisms behind such effects are “not very well understood” but may be related to dopamine availability. “GLP-1 inhibits and indirectly implies the amount of dopamine or dopamine transporters…because dopamine is induced by many of these substances we ingest, somehow we are You don’t get a lot of pleasure, or you don’t get that much reward, and that’s part of the fun of taking them.”
Another may involve the neurotransmitter GABA. Lorenzo Reggio, M.D., National Institute of Alcohol Abuse and Alcoholism, co-authored a recent study The researchers found that semaglutide reduced “binge-like” drinking and alcoholism in mice and rats, respectively. This was true for both males and females, and rodents also showed an aversion to sweet solutions.
Reggio said drugs used for alcohol use disorders, such as acamprosate (Campral), act on GABA.
The study “shows that semaglutide influences several key addiction-related factors in the brain, such as dopamine and GABA,” Reggio told MedPage Today. “So this is another piece of pie, another piece of evidence that semaglutide is acting on systems in the brain that we know are important for addiction.”
Professor Reggio is currently working on a protocol for a randomized controlled trial examining the use of semaglutide and alcohol in humans, and is collaborating with Oklahoma State University on a similar study.
There is still some disagreement about how GLP-1 works. signal is sent In the gut and brain, he said. What he and others are studying is how GLP-1 is produced in the brain and how GLP-1 is produced in the body. intestinal interactionThis will allow us to know if the effects of semaglutide in reducing alcohol consumption are related to the effects of semaglutide in the body.
But doctors like Srivastava and endocrinologist Jody Duchey, M.D., at Beth Israel Deaconess Medical Center in Boston, are noticing real-world signs.
Dushay told MedPage Today that a small number of patients taking GLP-1 agonists have reduced cravings and use of alcohol. “Anecdotally, it’s true,” she said. However, she said, “I only heard it from people who naturally talked about it, so very few people mentioned alcohol.”
Few of Ms. Duchey’s patients are smokers, she added, and she has not heard from patients about other behaviors such as shopping or using the phone.
Duchey also wondered if nausea, a common side effect of semaglutide, also played a role in alcohol avoidance. She estimates that about 85% of her patients experience some degree of nausea.
“Some people might say, ‘I’m not nauseous and I didn’t really want to drink,'” she says. “And some people say, ‘I don’t even want to drink because it makes me nauseous.’ So it could be either or both.”
However, nausea is usually short-lived as people develop a tolerance to semaglutide. Dushey et al. say that this phenomenon could be due to a general blunting of the hedonic response.
“It is not at all surprising that some people find that they are not getting enjoyment from activities they used to enjoy,” she noted. “Maybe I just stopped feeling itchy.”
Experts also warned of the potential risk of serious mental health problems that can result from a diminished ability to experience pleasure, the so-called hedonic ataxia. labeling Because Wegovy contains a warning about suicidal ideation and advises against prescribing it to patients with a history of suicidal ideation.
“This is precisely why we need to do double-blind, placebo-controlled studies, not only for the efficacy we expect, but especially because people with alcohol use disorders and addictions commonly have comorbidities. That’s why. Other mental health problems, including depression, coexist,” Reggio said, emphasizing the importance of closely monitoring symptoms of depression.
However, he said, “Semaglutide is being prescribed worldwide and there are no red flags, so based on what we know so far, we’re definitely… not worried.” added.
Another major uncertainty, Drucker noted, is the dose-response relationship required to produce inhibition of addictive behavior when compared to weight loss or diabetes management.
“Are they the same? In that case, you don’t want everyone to lose weight if you’re necessarily trying to reduce smoking cessation or dependence. Can’t we get by with a dose? Loss? Drucker said, “That’s a really interesting question. We don’t have enough data to answer it.”
Ultimately, experts agreed that every patient is different and there is still no way to predict how someone will respond to semaglutide or other GLP-1 agonists.
“As a frequent prescriber, it’s good to know that you need to ask your patients about all of these things, rather than just asking, ‘How many pounds have you lost?'” Duchey said. “TRUE [ask], “What is this drug doing in your body?” And instead of just putting someone on the scale and adjusting the dose, start asking broader questions. “
“Do you think semaglutide will dramatically save the world from addiction? The answer is no,” Reggio said. “If you ask me, ‘Do you think semaglutide is a promising drug to help people with alcohol use disorders?'” I think the answer is yes. “
