When starting medication for alcohol use disorder before discharge, the choice usually turns on liver, kidneys and opioids. Naltrexone is effective but blocks opioids — do not use it in anyone taking or likely to need opioids — and should be avoided in decompensated liver disease or acute hepatitis. Acamprosate is cleared by the kidney and not the liver, so it suits patients with liver disease, but needs dose reduction in moderate renal impairment and should not be used when creatinine clearance is 30 mL/min or less. Neither treats withdrawal; both are best started once the patient is abstinent or nearly so.
- Opioids now or planned: avoid naltrexone
- Decompensated cirrhosis or acute hepatitis: prefer acamprosate
- CrCl 30 mL/min or less: avoid acamprosate
- Check liver tests at baseline if using naltrexone
Why it matters
Medication is the component of AUD discharge bundles least often given, and the choice is usually quick to make.
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