PCSS-MAUD: AUD Psychopharmacology in those with Co-Morbid Medical Conditions-Slides

Slides

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This webinar reviewed how to use medications for alcohol use disorder (MAUD) in patients with common serious medical comorbidities, with emphasis on practical dosing and safety considerations rather than treatment of the comorbid conditions themselves. The main conditions discussed were liver disease, infectious disease, respiratory illness, cardiovascular disease, and renal disease.<br /><br />Key takeaways for liver disease were that alcohol-associated liver disease is common and severe, but MAUD generally improves outcomes by reducing alcohol use and slowing progression of liver injury. Naltrexone is often avoided unnecessarily; the presenter emphasized that, with sensible monitoring, it is usually safe in compensated liver disease and often still reasonable even in more advanced disease. Acamprosate, gabapentin, topiramate, and baclofen are generally usable, though renal function and sedation must be considered. Disulfiram was highlighted as the main exception: it should generally be avoided in alcohol-associated liver disease because of hepatotoxicity risk.<br /><br />For infectious disease, alcohol use increases risk for HIV, hepatitis, tuberculosis, STIs, and other infections, largely through immune dysfunction and behavioral risk. MAUD may indirectly reduce infection risk over time by supporting abstinence, but direct evidence is limited.<br /><br />In respiratory disease, caution is needed with gabapentin and baclofen because of respiratory depression or CNS depression, especially in people with underlying lung disease or sleep apnea. Topiramate can cause metabolic acidosis, which may matter in severe respiratory disorders.<br /><br />For cardiovascular disease, disulfiram can be dangerous because alcohol-disulfiram reactions may cause collapse, arrhythmias, and MI. Most other MAUD options require little or no cardiac dose adjustment.<br /><br />In renal disease, acamprosate and baclofen need dose reduction or avoidance depending on kidney function; gabapentin and topiramate also require renal dosing adjustments.<br /><br />The talk closed by noting emerging evidence that GLP-1 receptor agonists may reduce drinking and improve liver-related outcomes, though more data are needed.

Keywords

alcohol use disorder

medications for alcohol use disorder

liver disease

naltrexone

acamprosate

disulfiram

gabapentin

topiramate

baclofen

renal dosing