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

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.

This article reviews recent key research to assist naltrexone prescribing, including prescribing for patients with liver disease.

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.