Naltrexone is an evidence-based intervention for substance use disorders, including alcohol use disorder. Naltrexone is contraindicated in acute hepatitis and liver failure. In patients without suspected liver disease, pre-initiation liver function screening should not delay naltrexone treatment initiation. Based on available research, there is minimal risk of hepatoxicity associated with naltrexone prescribed at standard dose to treat alcohol use disorder (50mg). Additionally, the delay in treatment may result in patients being lost to care and not receiving an intervention that has the potential to support recovery. Periodic monitoring of liver enzymes is recommended for the alcohol use disorder population as part of comprehensive care.
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