Off-Label Medications for Alcohol Use Disorder Among Patients With HIV: Pilot Study 1

Prior treatment

• Life-threatening or unstable medical, surgical, or psychiatric condition that prohibits participation (including current or past intent to harm oneself or others within the prior 12 months and not receiving treatment
• Already prescribed the pilot medication at the time of study recruitment.

Other illness

• Active engagement in formal alcohol treatment including medications for alcohol use disorder at the time of enrollment
• Untreated moderate to severe opioid use disorder
• History of serious hypersensitivity or adverse reaction to study medication

Lab values

• Self-report or laboratory test confirming pregnancy, nursing, or trying to conceive
• Taking potentially interactive medication(s): eplerenone, potassium supplementation, lithium, digoxin, cholestyramine, heparin and low-molecular weight heparin for spironolactone)
• Hyperkalemia defined as serum potassium ≥ 5.0 mEq/L on the most recent laboratory test performed in the past 60 days prior to enrollment or Addison's disease or estimated glomerular filtration rate \<50 mL/min/1.73 m2 (for spironolactone)
• Creatinine level of ≥1.5 mg/dl (for spironolactone)

Other

• Residence out of state
• Inability to read or understand English

• diagnosed with HIV
• Receive care at the Atlanta VA Healthcare System
• Age 18 or over
• Meet criteria for mild, moderate, or severe alcohol use disorder by the DSM-5 Alcohol Symptom Checklist and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen
• Have evidence of significant alcohol use: PEth \> 20ng/ml
• Prescribed \>=5 medications
• Have cell phone or reliable contact number
• Can provide written informed consent