Apremilast

Alcohol use disorder (AUD) affects approximately 400 million people worldwide and is frequently accompanied by chronic pain, a major yet often overlooked predictor of relapse. Emerging evidence suggests that neuroinflammatory mechanisms may contribute to both excessive alcohol consumption and pain sensitivity. Apremilast, a phosphodiesterase-4 (PDE4) inhibitor approved for inflammatory conditions such as psoriasis and psoriatic arthritis, has recently been investigated as a potential dual-action treatment for AUD. Preclinical studies demonstrate that apremilast significantly reduces alcohol intake across animal models, including genetically predisposed high-drinking strains. The drug decreases binge-like drinking and motivation for alcohol, while also lowering mechanical allodynia both during active drinking and throughout prolonged abstinence. Unlike other PDE4 inhibitors, apremilast combines anti-inflammatory and analgesic effects with reductions in alcohol-seeking behaviour, addressing two key drivers of relapse. Given the high comorbidity of AUD and chronic pain, this dual mechanism may offer a promising personalized therapeutic approach. Although early preclinical and limited clinical findings are encouraging, robust randomized controlled trials are needed to confirm efficacy and safety in humans and to evaluate potential benefits on withdrawal-related anxiety and negative affect.