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Medications for Alcohol Use Disorder Naltrexone: Contraindicated in patients actively using opioids may precipitate withdrawal 17 Naloxone Challenge No consensus on trial dose (0.2 0.4mg IV), we recommend administering 0.4mg IV and observing for signs of withdrawal 17,18 No longer a black box warning for use in patients with liver dysfunction, but may be beneficial to order baseline LFTs Evidence: NNT of 12 to reduce the risk of return to heavy drinking A pilot study demonstrated that initiation of 50 mg in the ED was feasible Extended-release naltrexone was well-liked by patients and associated with significantly improved quality of life and reduced alcohol consumption 15,19,20 Acamprosate: Not metabolized by the liver, safe in patients with liver disease, contraindicated in patients with severe renal impairment A high daily pill burden may reduce adherence Evidence: NNT of 11 to reduce return to heavy drinking 21,22 Significantly increases the likelihood of maintaining abstinence Shown to be most effective when patients have already stopped drinking 21 Demonstrated to be significantly more effect when compared to baclofen for reducing alcohol use 23 Disulfiram: Aversive agent Disulfiram reaction Accumulation of acetaldehyde, leading to flushing, nausea, and vomiting May reduce adherence Evidence: Comparable to naltrexone in one study, for maintaining abstinence and reducing heavy drinking Most effective when administered in a supervised program 2426 Studies have demonstrated that disulfiram can help to maintain abstinence in well-selected patients, but RCTs have not shown efficacy 24,27,28 In a large meta-analysis, evidence for disulfiram was poor, and a NNT was unable to be calculated 19 Gabapentin: Initially FDA-approved as an antiepileptic, then later to treat neuropathic pain, is not FDA-approved for alcohol use disorder 29 Potential risk of misuse or abuse, but reports and data are inconclusive 16,30 Evidence: In an RCT of 150 patients, gabapentin was found to significantly increase abstinence rates, reduced heavy drinking days, and cravings when compared to placebo 31 NNT of 8 (lower than naltrexone or acamprosate) 31 Long-term trials have not displayed sustained efficacy Use of AUD Medications in the ED: Medications for alcohol use disorder are underutilized in the ED, with fewer than 1% of patients with AUD being started on treatment each year

And so these GLP-1 receptors are found all throughout the body