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Might Semaglutide Prompt Less Alcohol Use?

We would classify this as a report of a side effect. But it’s not really an adverse event. It seems that for some people, the use of semaglutide has prompted less alcohol use. In the New York Times, Dani Blum describes the experience of one patient:

“In August 2022, Eva Monsen’s endocrinologist prescribed Ozempic [semaglutide] to treat her diabetes. Almost immediately, she said, she lost her desire to drink. When she poured herself a glass of wine, ‘I felt no pleasure from it at all,’ she said.

“A part of her missed the comforting blur from being tipsy. When she tried to drink while on Ozempic, though, she felt dizzy and nauseated — but not intoxicated. ‘I was just incapable of feeling the buzz,’ said Ms. Monsen, who lives in Seattle. Now, she barely drinks at all.”

An Observation from Animal Studies

Let’s be clear. Alcohol use disorder is not an indication for a GLP-1 agonist like semaglutide. However, this observation in humans is not totally surprising because researchers have studied it in animals. Vincent Marty and colleagues studied the effects of both liraglutide and semaglutide on alcohol use in rats. They found that both of these drugs caused rats to consume less alcohol when they had the option. They also found that semaglutide, but not liraglutide, reduced the preference of rats for alcohol.

Mette Kruse Klausen and colleagues reviewed the research on this recently and wrote in the British Journal of Pharmacology:

“Studies in rodents and non-human primates have demonstrated a reduction in intake of alcohol and drugs of abuse, and clinical trials have been initiated to investigate whether the preclinical findings can be translated to patients.

“We suggest that effects of GLP-1 in alcohol and substance use disorders is mediated centrally, at least partly through dopamine signalling, but precise mechanisms are still to be uncovered.”

Different from Bariatric Surgery

Of course, this is very different from the experience with bariatric surgery, where new cases of alcohol use disorder (AUD) can occur in patients after bariatric surgery. In one study, the prevalence of AUD rose from 9.6 percent before surgery to 14.0 percent two years after surgery. An increase was seen in both sleeve and bypass patients.

Pathways in the Brain

Research on this phenomenon is ongoing and it’s important because the options for treating alcohol use disorder are limited. Some research suggests that GLP-1 agonists can reduce the reactivity of brain pathways linked to reward and addiction for persons with AUD.

A better understanding of these pathways and their role in obesity and substance use disorders is a fascinating prospect.

Click here (gift access) for Blum’s reporting in the Times, here for the study by Marty et al, and here for the review by Klausen et al.

Olympic Cocktail, photograph by EWikiLearner, licensed under CC BY 4.0

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March 8, 2023