Pharmacotherapy to Prevent Alcohol Relapse in Alcohol-Associated Liver Disease.
Wei Zhang, Soo Young Hwang, Jay Luther
Current gastroenterology reports November 19, 2025 DOI: 10.1007/s11894-025-01026-x (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Randomized Peer reviewed |
|---|---|
| Interventions | Naltrexone Acamprosate Baclofen Gabapentin Topiramate Psilocybin |
| Topics | Addiction |
| Keywords | Acamprosate Alcohol‑associated liver disease Baclofen Integrated care Liver transplantation Naltrexone Pharmacotherapy Relapse prevention Alcohol-associated liver disease |
| Citations | 1 |
| Key findings | Pharmacotherapy is effective but underused for relapse prevention in alcohol-associated liver disease. |
Abstract
Alcohol use disorder (AUD) drives alcohol-associated liver disease (ALD), and relapsing after abstinence remains a significant challenge before and after transplantation. This review summarizes evidence for pharmacotherapies in relapse prevention and their integration into ALD care. Naltrexone and acamprosate reduce the relapse in the general AUD population, though data in ALD are limited. Baclofen is the only drug tested in randomized trials in cirrhosis, with early benefit but mixed results in later studies. Gabapentin and topiramate are promising off-label options. Emerging agents include glucagon-like peptide-1 (GLP-1) receptor agonists, psilocybin, and fibroblast growth factor-21 (FGF21) analogs, all showing early signals in reducing alcohol use. Despite guideline support, pharmacotherapy is underutilized in ALD due to lack of insight, stigma, provider inexperience, and fragmented care. Integrated programs across the disease spectrum demonstrate feasibility and may improve pharmacotherapy uptake. Pharmacotherapy is effective yet underused for relapse prevention in ALD. Integration with behavioral interventions and multidisciplinary care is essential to expand access, evaluate novel therapies, and improve patient outcomes.