Table 2. Medication-assisted Therapy for AUD in ALD.

Medication	Dosing	Mechanism	Treatment considerations for AUD in ALD
Naltrexone	50–150 mg QD; 380 mg IM monthly	Opioid receptor antagonist	FDA approved for AUD; a large number of studies show efficacy; no RCTs in ALD patients. It is heavily metabolized by liver and while hepatotoxicity risk is rare it may occur at high doses
Acamprosate	333–666 mg TID	NMDA receptor antagonist	FDA approved for AUD, a large number of studies show efficacy; no RCTs in ALD patients. No hepatic metabolism but it is contraindicated in severe renal insufficiency
Topiramate	100–400 mg BID	GABA and glutamate modulator	RCTs with a dose escalation design showed efficacy; no RCTs in ALD patients
Ondansetron	1–16 microg/kg BID	5-HT3 receptor antagonist	One RCT showed reduced drinking in the more severe AUD type 2; no RCTs in ALD patients. Hepatic metabolism but no reports of toxicity
Gabapentin	600–1,800 mg TID	GABA modulator	RCTs with comorbid anxiety disorders and insomnia showed efficacy; no RCTs in ALD patients. Minimal hepatic metabolism and no reports of hepatotoxicity. Dose adjustments for ESRD
Baclofen	10–60 mg TID	GABAB receptor agonist	One RCT evidence for efficacy in advanced ALD   Minimal hepatic metabolism and no reports of toxicity

ALD, alcohol-related liver disease; AUD, alcohol use disorder; QD, once a day; NMDA, N-methyl-D-aspartate; IM, intramuscular; RCT, randomized controlled trial.