Diaz 2025: naltrexone shots in advanced alcohol-related liver disease

What they tested

Doctors at one tertiary care centre reviewed the records of adults with alcohol-associated liver disease who got at least one 380 mg intramuscular injection of extended-release naltrexone between 2023 and March 2025. Each was followed for at least 12 weeks.

They tracked side effects, liver blood tests and liver disease scores (MELD and Child-Pugh). Drinking was measured with phosphatidylethanol (PEth), a blood test that reflects recent alcohol use.

What they found

Of the 14, 2 had advanced liver scarring (stage F3) and 9 had cirrhosis rated Child A–B. The median age was 51, and 64% were men.

Four people (29%) had mild side effects: pain at the injection site, nausea and vomiting, fatigue, and sexual side effects. None had liver toxicity or liver decompensation, and liver tests and MELD and Child-Pugh scores didn't change significantly.

Eight (57%) drank less, but the decline in PEth levels was not statistically significant.

Limits

• With 14 people and no comparison group, it can't detect rare liver harm or show that the shot reduced drinking.
• It was a retrospective review of records from a single centre.
• Follow-up was short, a median of 127 days.

What it means if you're considering naltrexone

Worry about liver damage is one reason alcohol medicines are underused in people with serious liver disease. The shot avoids first-pass metabolism in the liver, which is why some see it as a safer option for them. This small series found no liver harm, which is reassuring but far from proof.