SY04-3MANAGEMENT OF ALCOHOL DEPENDENCE IN PATIENTS WITH ALCOHOLIC CIRRHOSIS

Abstract

Alcohol dependence represents a chronic and relapsing disease affecting nearly10%ofthegeneralpopulationbothintheUnited States andinEur‐ope, with a widespread burden of morbidity and mortality. Alcohol dependence represents the most common cause of liver damage in the Western Countries. Although alcoholic liver disease is associated primar‐ilywithheavydrinking,continuedalcoholconsumption,eveninlowdoses after the onset of liver disease, increases the risk of severe consequences, includingmortality. Consequently,the ideal treatmentofpatientsaffected by alcohol dependence andalcoholic liver disease should aimatachieving long‐term total alcohol abstinence and preventing relapse. The present lecture will provide an update on the pharmacological management of alcohol dependence in patients with alcoholic liver disease. Increasing evidences suggests the usefulness of psychosocial interventions and medications combined in order to reduce alcohol intake, promote abstinence and prevent relapse in alcohol dependent patients. Disulfiram, naltrexone and acamprosate have been approved for this indication; gamma‐hydroxybutyric acid (GHB) is approved in Italy and Austria. However, these drugs have not been tested in patients with advanced liver disease. Amongst other emerging pharmacotherapies for alcoholism, topiramate, ondansetron, and baclofen seem the most promising ones. Both topiramate and ondansetron hold a safe profile in alcoholic patients; however, none of them has been tested in alcoholic patients with advanced liver disease. To date, baclofen represents the only anti‐craving medication formally tested in a randomized clinical trial in alcoholic patients affected by liver cirrhosis, although additional confirmatory studies are warranted.