The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the Editor
In the good review on long-term drug treatment of patients with alcohol dependence (Aust Prescr 2015;38:41-3), the important issue of underuse of pharmacotherapy for alcohol dependence is identified and an outline of treatment is given. However, the article states that naltrexone is contraindicated in acute hepatitis or liver failure. In my clinical practice, varying degrees of chronic liver disease are commonly encountered when treating an alcohol-dependent population. Continued heavy drinking is much more likely to pose a greater risk to liver function than naltrexone. Arguably, the risk−benefit assessment likely favours naltrexone treatment. Naltrexone can be prescribed in patients with stable or compensated cirrhosis but is not recommended in acute liver failure. It carries a low risk of hepatotoxicity. However, in my experience, many potentially suitable patients are not given the drug because of concerns about hepatotoxicity.
Western Health, Melbourne
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