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Pharmacotherapy for alcoholic patients with alcoholic liver disease.
Am J Health Syst Pharm 2014; 71(15):1265-76AJ

Abstract

PURPOSE

An update on pharmacotherapy for achieving and maintaining abstinence and mitigating hepatic damage in patients with alcoholic liver disease (ALD) is presented.

SUMMARY

Currently there are limited pharmacotherapy options for managing ALD, which encompasses a broad spectrum of disorders ranging from steatosis and alcoholic hepatitis to fibrosis, cirrhosis, and hepatocellular cancer. Individual variation in the severity, presentation, and complex pathologenesis of ALD defines barriers to effective treatment. Scoring of disease severity using validated assessment instruments should guide treatment approaches; abstinence and proper nutrition continue to be the cornerstones of management. A literature search (through December 31, 2013) identified no reports of randomized controlled trials using Food and Drug Administration (FDA)-approved medications for the treatment of alcohol dependence in ALD-spectrum disorders. Disulfiram, acamprosate, and naltrexone (oral and intramuscular), while approved by FDA for treatment of alcohol dependence, are not currently approved for use in patients with ALD. Baclofen (also not FDA-approved for use in ALD) is the only medication available in the United States with demonstrated safety and efficacy in reducing alcoholic behavior that has been formally tested in clinical trials in patients with ALD. Pharmacotherapy of alcoholic hepatitis using glucocorticoids or pentoxifylline has shown promise, but these options are reserved for severe ALD only.

CONCLUSION

Although various treatments have been investigated for ALD in patients with alcoholism, complete abstinence from alcohol is currently the only recommended form of hepatoprotection for the entire spectrum of ALD diagnoses.

Authors+Show Affiliations

Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University.Cynthia L. Vuittonet, M.D., is Resident Physician, Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Michael Halse, Pharm.D., is Resident Pharmacist, South County Hospital, Wakefield, RI. Lorenzo Leggio, M.D., Ph.D., M.Sc., is Section Chief, Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, and Section Chief, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, and Adjunct Associate Professor, Center for Alcohol and Addiction Studies, Brown University. Samuel B. Fricchione, B.A., is Research Assistant; Michael Brickley, B.A., is Research Assistant; Carolina L. Haass-Koffler, Pharm.D., is Post-Doctoral Fellow; and Tonya Tavares, M.A., is Senior Research Assistant, Center for Alcohol and Addiction Studies, Brown University. Robert M. Swift, M.D., Ph.D., is Deputy Chief of Research, Center for Alcohol and Addiction Studies, Brown University, Deputy Director of Research, Providence Veterans Affairs Medical Center, Providence, RI, and Professor of Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. George A. Kenna, Ph.D., B.S.Pharm., is Assistant Professor of Psychiatry (Research), Center for Alcohol and Addiction Studies, and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. george_kenna@brown.edu.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

25027533

Citation

Vuittonet, Cynthia L., et al. "Pharmacotherapy for Alcoholic Patients With Alcoholic Liver Disease." American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, vol. 71, no. 15, 2014, pp. 1265-76.
Vuittonet CL, Halse M, Leggio L, et al. Pharmacotherapy for alcoholic patients with alcoholic liver disease. Am J Health Syst Pharm. 2014;71(15):1265-76.
Vuittonet, C. L., Halse, M., Leggio, L., Fricchione, S. B., Brickley, M., Haass-Koffler, C. L., ... Kenna, G. A. (2014). Pharmacotherapy for alcoholic patients with alcoholic liver disease. American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 71(15), pp. 1265-76. doi:10.2146/ajhp140028.
Vuittonet CL, et al. Pharmacotherapy for Alcoholic Patients With Alcoholic Liver Disease. Am J Health Syst Pharm. 2014 Aug 1;71(15):1265-76. PubMed PMID: 25027533.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy for alcoholic patients with alcoholic liver disease. AU - Vuittonet,Cynthia L, AU - Halse,Michael, AU - Leggio,Lorenzo, AU - Fricchione,Samuel B, AU - Brickley,Michael, AU - Haass-Koffler,Carolina L, AU - Tavares,Tonya, AU - Swift,Robert M, AU - Kenna,George A, PY - 2014/7/17/entrez PY - 2014/7/17/pubmed PY - 2015/8/25/medline SP - 1265 EP - 76 JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JO - Am J Health Syst Pharm VL - 71 IS - 15 N2 - PURPOSE: An update on pharmacotherapy for achieving and maintaining abstinence and mitigating hepatic damage in patients with alcoholic liver disease (ALD) is presented. SUMMARY: Currently there are limited pharmacotherapy options for managing ALD, which encompasses a broad spectrum of disorders ranging from steatosis and alcoholic hepatitis to fibrosis, cirrhosis, and hepatocellular cancer. Individual variation in the severity, presentation, and complex pathologenesis of ALD defines barriers to effective treatment. Scoring of disease severity using validated assessment instruments should guide treatment approaches; abstinence and proper nutrition continue to be the cornerstones of management. A literature search (through December 31, 2013) identified no reports of randomized controlled trials using Food and Drug Administration (FDA)-approved medications for the treatment of alcohol dependence in ALD-spectrum disorders. Disulfiram, acamprosate, and naltrexone (oral and intramuscular), while approved by FDA for treatment of alcohol dependence, are not currently approved for use in patients with ALD. Baclofen (also not FDA-approved for use in ALD) is the only medication available in the United States with demonstrated safety and efficacy in reducing alcoholic behavior that has been formally tested in clinical trials in patients with ALD. Pharmacotherapy of alcoholic hepatitis using glucocorticoids or pentoxifylline has shown promise, but these options are reserved for severe ALD only. CONCLUSION: Although various treatments have been investigated for ALD in patients with alcoholism, complete abstinence from alcohol is currently the only recommended form of hepatoprotection for the entire spectrum of ALD diagnoses. SN - 1535-2900 UR - https://www.unboundmedicine.com/medline/citation/25027533/Pharmacotherapy_for_alcoholic_patients_with_alcoholic_liver_disease_ L2 - https://academic.oup.com/ajhp/article-lookup/doi/10.2146/ajhp140028 DB - PRIME DP - Unbound Medicine ER -