October 2025 Journal Club – Naltrexone (NTX) for Alcohol Use Disorder (AUD) in Cirrhosis

I have recently enjoyed working with addiction medicine fellows at Maine Medical Center. A patient was referred to our office with cirrhosis due to alcohol use disorder, to maybe start naltrexone (NTX). The fellow was nonplussed; why wouldn’t we start it? And there I was: Crusty. I had seen some folks with cirrhosis prescribed NTX, but the last advice I’d received from a hepatologist, maybe 5 years ago, was a pretty strong message to avoid its use in patients with cirrhosis: compensated or decompensated. I myself had not made that prescribing decision. But as a 2025 paper (Shenoy et al) suggests, practice is changing. More people are receiving meds for AUD, including NTX, in the setting of cirrhosis. I needed to get up to speed to understand if this is something to emulate or something to watch out for. (Spoiler: mostly emulate).