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PRACTICE POINTERS BY ALYSSA BRUEHLMAN, MD, University of Pennsylvania, Philadelphia, Pennsylvania

PRACTICE POINTERS BY ELIZABETH SALISBURY-AFSHAR, MD, MPH, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin

Am Fam Physician. 2024;109(5):459-462

Related article: Medications for Alcohol Use Disorder

 This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Clinical Issue

What are the potential benefits and adverse effects of medications used to treat alcohol use disorder (AUD) in adults in outpatient settings?

Evidence-Based Answer

Oral naltrexone (Revia), 50 mg daily, reduces alcohol consumption across multiple outcomes, and once-daily dosing offers relative ease of use. (Strength of Recommendation [SOR]: C, disease-oriented evidence.) Acamprosate and topiramate also have evidence of benefit for reducing alcohol consumption; however, acamprosate has a higher pill burden, and topiramate has a less desirable adverse effect profile. (SOR: C, disease-oriented evidence.) There is lower strength of evidence for reducing alcohol consumption when using injectable naltrexone (Vivitrol), baclofen, or gabapentin. (SOR: C, disease-oriented evidence.) Evidence remains inadequate for use of disulfiram compared with placebo for reducing alcohol consumption.1 Current data are insufficient to understand the effect of any of the pharmacotherapies for AUD on health outcomes (e.g., mortality, quality of life, function, accidents, injury).

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The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based on the review. AHRQ’s summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions.

This series is coordinated by Joanna Drowos, DO, MPH, MBA, contributing editor. A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq.

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