Semaglutide and alcohol: three trials and a warning removed

From anecdote to trial

GLP-1 agonists act on reward circuits: in rodents, exendin-4 blunted alcohol-induced dopamine release in the nucleus accumbens and reduced intake⁹, and semaglutide reduced intake and relapse-like drinking in rats of both sexes¹⁰. In alcohol-preferring vervet monkeys, liraglutide and, to a lesser extent, exenatide reduced voluntary drinking¹¹. And for years patients were described who drank less: of 1,580 Reddit posts about alcohol and these drugs, 71% described less desire to drink¹³. Cohorts suggested it: in one using electronic health records of 83,825 patients with obesity, semaglutide, vs other anti-obesity medications, was associated with a 50–56% lower risk of incident and recurrent alcohol use disorder over 12 months⁵. In Sweden, with 227,866 people with alcohol use disorder and a within-individual design, it was associated with fewer alcohol hospitalizations: aHR 0.64 for semaglutide and 0.72 for liraglutide, vs 0.98 for approved alcohol-use-disorder drugs⁴.

The three trials

JAMA Psychiatry 2025 (48 adults, 9 weeks): less alcohol consumed in the lab session, fewer drinks per drinking day and less craving; no change in drinks per day or drinking days¹.
The Lancet 2026 (108 patients with obesity, 26 weeks, with CBT): heavy-drinking days fell by 41.1 vs 26.4 percentage points; difference −13.7 (P = 0.0015)².
Am J Psychiatry 2026 (50 patients, oral semaglutide): no effect on lab craving or drinks per day; heavy-drinking days and drinks per drinking day fell³.

−13.7percentage points in heavy-drinking days (Lancet 2026)²

aHR 0.64alcohol hospitalization on semaglutide (Sweden)⁴

107,910patients in the FDA suicidality analysis⁶

The honest reading: the signal is now replicated in trials, but the effects are modest and concentrated in heavy drinking¹²³. Earlier, an exenatide trial in 127 patients did not reduce heavy-drinking days vs placebo, although an exploratory analysis found a reduction in the subgroup with obesity¹². There is no approved indication for alcohol use disorder.

The suicidal-ideation warning

In January 2026 the FDA issued a safety communication based on its own meta-analysis of "91 placebo-controlled GLP-1 RA medication trials" with 107,910 patients and concluded there was no increased risk of suicidal ideation or behavior. It asked for the warning to be removed from the Wegovy, Saxenda and Zepbound labels⁶. The Wegovy label already shows the section as removed in 01/2026⁷. It was in line with the European Medicines Agency, whose PRAC committee concluded in April 2024 that the evidence did not support a causal association with suicidal or self-injurious thoughts¹⁵, and with a cohort of 240,618 patients with overweight or obesity in which semaglutide was associated with a lower risk of incident suicidal ideation (HR 0.27) vs other anti-obesity medications¹⁴.

Sources

Hendershot CS, et al. Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry. 2025;82(4):395-405. PubMed 39937469 ↗
Klausen MK, et al. Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity. Lancet. 2026;407(10540):1687-1698. PubMed 42070571 ↗
Schacht JP, et al. Oral semaglutide for alcohol use disorder: a randomized clinical trial. Am J Psychiatry. 2026;183(9):636-645. PubMed 42522065 ↗
Lähteenvuo M, et al. Repurposing semaglutide and liraglutide for alcohol use disorder. JAMA Psychiatry. 2025;82(1):94-98. PubMed 39535805 ↗
Wang W, et al. Associations of semaglutide with incidence and recurrence of alcohol use disorder in real-world population. Nat Commun. 2024;15(1):4548. PubMed 38806481 ↗
U.S. Food and Drug Administration. Drug Safety Communication: FDA requests removal of suicidal behavior and ideation warning from glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications. 13 January 2026. fda.gov ↗
Novo Nordisk. Wegovy (semaglutide) US prescribing information, revised 06/2026. novo-pi.com ↗
McCall KL, et al. Safety analysis of compounded GLP-1 receptor agonists: a pharmacovigilance study using the FDA adverse event reporting system. Expert Opin Drug Saf. 2026;25(3):581-588. PubMed 40285721 ↗
Egecioglu E, Steensland P, Fredriksson I, Feltmann K, et al. The glucagon-like peptide 1 analogue Exendin-4 attenuates alcohol mediated behaviors in rodents. Psychoneuroendocrinology. 2013;38(8):1259-70. PubMed 23219472 ↗
Aranäs C, Edvardsson CE, Shevchouk OT, Zhang Q, et al. Semaglutide reduces alcohol intake and relapse-like drinking in male and female rats. EBioMedicine. 2023;93:104642. PubMed 37295046 ↗
Thomsen M, Holst JJ, Molander A, Linnet K, et al. Effects of glucagon-like peptide 1 analogs on alcohol intake in alcohol-preferring vervet monkeys. Psychopharmacology (Berl). 2019;236(2):603-611. PubMed 30382353 ↗
Klausen MK, Jensen ME, Møller M, Le Dous N, et al. Exenatide once weekly for alcohol use disorder investigated in a randomized, placebo-controlled clinical trial. JCI Insight. 2022;7(19). PubMed 36066977 ↗
Quddos F, Hubshman Z, Tegge A, Sane D, et al. Semaglutide and Tirzepatide reduce alcohol consumption in individuals with obesity. Sci Rep. 2023;13(1):20998. PubMed 38017205 ↗
Wang W, Volkow ND, Berger NA, Davis PB, et al. Association of semaglutide with risk of suicidal ideation in a real-world cohort. Nat Med. 2024;30(1):168-176. PubMed 38182782 ↗
European Medicines Agency. Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 8-11 April 2024: GLP-1 receptor agonists: available evidence not supporting link with suicidal and self-injurious thoughts and actions. 12 April 2024. ema.europa.eu ↗

Informational article. It summarizes news, official statements and published studies; it is not medical or legal advice. Sources were checked on the publication date.