Two existing medications – one for smoking cessation and the other for treating depression – appear to work effectively together in the treatment of alcohol problems. The combination reduces cravings for alcohol, lowers consumption and can reduce the risk of nausea. These findings come from a new study led by the University of Gothenburg, Sweden.

Alcohol dependence is a serious condition that can shorten the lives of people with severe forms of the disorder by 25 years or more. However, existing treatments are only effective for a small group of patients.

The results are published in The Lancet Regional Health – Europe. The study was conducted in collaboration with researchers from Karolinska Institutet, Lund University and Linköping University. It presents a possible new treatment strategy: increasing dopamine levels in the brain.

The researchers based their approach on the hypothesis that a lack of dopamine promotes alcohol cravings. They aimed to enhance dopamine signaling by combining varenicline, which stimulates dopamine release via nicotinic receptors, with bupropion, which helps the brain maintain dopamine levels after release.

Reduced consumption in 13-week study

A total of 384 people with moderate to severe alcohol dependence took part in the 13-week study. The participants were randomly assigned to one of four groups and received either the combination treatment, one of the two drugs alone or a placebo. Neither the participants nor the researchers knew who received what during the study.

The results showed that alcohol consumption decreased the most in the participants who received the combination therapy. Varenicline alone also had a measurable effect. The results were assessed using both blood biomarkers(B-PEth, which reflects long-term alcohol consumption) and self-reports.

An important secondary finding was that the combination treatment caused less nausea, which is a known side effect of varenicline. For those who did experience nausea, symptoms lasted for a shorter period of time, similar to the placebo group.

Original Paper:

Efficacy and safety of varenicline and bupropion, in combination and alone, for alcohol use disorder: a randomized, double-blind, placebo-controlled multicentre trial – The Lancet Regional Health – Europe

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