Naltrexone: A safe and effective standard of care in treating alcohol use disorder

BACKGROUND: Harmful alcohol consumption is a common presentation in primary care. Naltrexone is a safe and effective treatment for alcohol use disorder (AUD) that remains underused because of prescriber unfamiliarity, inconsistencies in guidelines, stigma and historical safety considerations. OBJECTIVE: This article reviews recent key research to assist naltrexone prescribing, including prescribing for patients with liver disease. DISCUSSION: Naltrexone is prescribed for fewer than 3% of patients with AUD in Australia, including patients with alcohol-related liver disease who access tertiary care and for whom treatment can be lifesaving. Evidence indicates that naltrexone is safe for patients with severe alcohol-associated cirrhosis. Naltrexone's safety in patients with severe acute hepatitis or acute-on-chronic liver failure remains unknown; however, naltrexone's ability to reduce alcohol consumption may outweigh any risks. Prescribers can align treatment with the patient's goal: naltrexone can be initiated with or without prior alcohol withdrawal, and targeted (non-daily) dosing is suitable for some patients.