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This study aims to investigate the use of metadoxine as a potential pharmacotherapy for alcohol dependence (AD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective study of 94 outpatients with AD, who received metadoxine for alcohol intoxication and were assessed for alcohol consumption, craving [Visual Analog Scale (VAS)] and liver\u2010related and alcohol\u2010related biomarkers [aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma\u2010glutamyl\u2010transpeptidase, mean corpuscular volume].<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Range of metadoxine dose was 500\u20132000\u2009mg\/day, with a mean dose of 1277(s.d.290)\u2009mg\/day, and for a period of 2\u201342\u2009days, with a mean period of 8.9(s.d.7.0)\u2009days. Follow\u2010up data were available for 52 patients (55.3%); 35(67.3%) patients were completely abstinent. There was a significant decrease in drinks per week, even after substituting baseline drinking as follow\u2010up data for dropouts (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and examining drinking pre\u2010treatment and post\u2010treatment for those who did not achieve abstinence (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There was a significant decrease in the VAS (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and a significant improvement in the AST\/ALT ratio (<jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Despite important limitations, this study represents a further preliminary observation suggesting metadoxine as a novel alcohol pharmacotherapy, including in alcohol\u2010dependent patients with ALD. 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