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Despite the prevalence and morbidity of alcohol use disorder (AUD), pharmacotherapy for AUD is underutilized by primary care clinicians and by hospitalists (NEJM JW Gen Med Aug 1 2023 and Ann Intern Med 2023 Aug; 176:1137). Options include three medications that are U.S. FDA–approved for AUD (i.e., acamprosate, naltrexone, and disulfiram) and several that are used off-label (e.g., topiramate, baclofen, gabapentin).
To compare these medications, researchers undertook a meta-analysis to evaluate 118 randomized outpatient trials with durations of at least 12 weeks. Key findings include the following:
Acamprosate and oral naltrexone (50 mg/day) decreased alcohol consumption. The numbers needed to treat (NNT) to prevent 1 person from returning to …