TABLE 1

Pharmacotherapy for alcohol use disorder

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 drinking	Oral: 50–100 mg daily Subcutaneous: 380 mg monthly	Generally first-line treatment given ease of dosing Contraindicated in concurrent opioid use or acute hepatitis Discuss risks and benefits in decompensated cirrhosis
Acamprosate	Number needed to treat of 11 to prevent return to any drinking^a	Oral: 666 mg 3 times daily	Safe in liver disease Contraindicated in severe kidney impairment
Disulfiram	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 ingestion
Topiramate^b	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 cirrhosis
Gabapentin^b	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 disorders
Baclofen^b	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 disease

↵^aBenefit only found in European trials where abstinent patients were recruited from treatment centers. Benefit not demonstrated in US trials with a more general population.
↵^bOff-label use.
Based on information from references 12–15.