Pharmacotherapy to Prevent Alcohol Relapse in Alcohol-Associated Liver Disease.
Current gastroenterology reports – November 19, 2025
Source: PubMed
Summary
For those with alcohol-associated liver disease, preventing relapse from alcohol use disorder is critical, especially around liver transplantation. While pharmacotherapy like Naltrexone and Acamprosate effectively aids relapse prevention, and Baclofen shows promise even in cirrhosis, these treatments are often underutilized. However, integrated care models are proving highly successful in expanding access and improving patient outcomes through better uptake of these vital medications.
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.