Article Figures & Data
Figures
- Figure 1
Proposed algorithm for liver disease screening in the primary care setting.
Tables
Medication Efficacy Typical dosage Notes Naltrexone Number needed to treat of 11 to prevent return to heavy drinking
Number needed to treat of 18 to prevent return to any drinkingOral: 50–100 mg daily
Subcutaneous: 380 mg monthlyGenerally first-line treatment given ease of dosing
Contraindicated in concurrent opioid use or acute hepatitis
Discuss risks and benefits in decompensated cirrhosisAcamprosate Number needed to treat of 11 to prevent return to any drinkinga Oral: 666 mg 3 times daily Safe in liver disease
Contraindicated in severe kidney impairmentDisulfiram Limited data suggest only effective when given under supervision Oral: 250–500 mg daily Contraindicated if any alcohol was used in preceding 12–48 hours
Can cause severe reaction if alcohol is consumed up to 14 days after ingestionTopiramateb Reduced percentage of drinking days and heavy drinking days Oral: maximum 100–150 mg twice daily More significant side-effect profile
Requires slow dose escalation
Use with caution in decompensated cirrhosisGabapentinb Limited data suggest may reduce drinking in patients with protracted withdrawal symptoms Oral: up to 1,800 mg daily in 2 or 3 divided doses More significant side-effect profile
Risk of misuse, especially with other substance use disordersBaclofenb Variable efficacy seen in trials, likely more effective in patients already abstinent Oral: 10–25 mg 3 times daily Safe in hepatic impairment Glucagon-like peptide 1 agonists (eg, semaglutide)b Emerging evidence of reduced alcohol intake Subcutaneous: weekly Multiple ongoing trials evaluating benefit and safety
Can target comorbid metabolic dysfunction–associated liver diseaseQuestion Score 0 points 1 point 2 points 3 points 4 points How often did you have a drink containing alcohol in the past year? Never Monthly or less 2–4 times per month 2–3 times per week 4 or more times per week How many drinks did you have on a typical day if you were drinking in the past year? 1–2 3–4 5–6 7–9 10 or more How often did you have more than 6 drinks on 1 occasion in the past year? Never Less than monthly Monthly Weekly Daily or almost daily A score of 3 or higher in women or 4 or higher in men is considered positive for heavy drinking.
Adapted from reference 23.
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