{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:32:52Z","timestamp":1786116772160,"version":"build-2736575974"},"reference-count":66,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100007109","name":"University of Ferrara","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007109","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The pharmacological management of alcohol use disorder (AUD) currently includes six medications approved by different regulatory agencies worldwide: acamprosate (ACM), naltrexone (NTX), nalmefene (NMF), disulfiram (DF), baclofen, and sodium oxybate (SO). Their optimal use should be aligned with the main aims of treatment, namely reduction of alcohol consumption and maintenance of complete abstinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This brief review summarizes the role of these six approved medications in AUD treatment and proposes practical treatment algorithms according to treatment goals, mechanisms of action, and clinically relevant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A focused narrative review of the literature was conducted, prioritizing meta-analyses, systematic reviews, randomized controlled trials, and relevant regulatory documents. Evidence on efficacy, safety, tolerability, and clinical applicability was interpreted pragmatically to support first-, second-, and third-line pharmacological strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For reducing alcohol intake, NMF or NTX are proposed as first-line pharmacotherapies, with baclofen considered as a second-line option when these agents are partially effective or ineffective. For maintaining abstinence, ACM is proposed as a first-line strategy. In selected clinical settings, including severe AUD, protracted alcohol withdrawal syndrome, high motivation for aversive treatment, or liver disease, SO, baclofen, DF, or NTX may serve as second-line options. Combined pharmacotherapy may be considered in highly adherent patients, whereas off-label drugs remain third-line options for refractory cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Improved knowledge of the efficacy, safety, and tolerability of the six approved medications may support more appropriate, individualized, and goal-oriented pharmacological management of patients with AUD. The proposed algorithms are intended as pragmatic tools to aid clinical decision-making rather than as formal guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/alcalc\/agag052","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T22:03:27Z","timestamp":1784585007000},"source":"Crossref","is-referenced-by-count":0,"title":["Six approved drugs for alcohol use disorder: algorithms for their use according to the aims of treatment"],"prefix":"10.1093","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8953-8338","authenticated-orcid":false,"given":"Fabio","family":"Caputo","sequence":"first","affiliation":[{"name":"Centre for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara , Via Borsari 46, 44121, Ferrara ,","place":["Italy"]},{"name":"Department of Internal Medicine, SS Annunziata Hospital , Via Vicini 2, 44042, Cento (Ferrara) ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teo","family":"Vignoli","sequence":"additional","affiliation":[{"name":"Department of Mental Health and Addiction, AUSL Romagna , Via Ovidio, 47900, Rimini ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Lungaro","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Ferrara , Vai Borsari 46, 44121, Ferrara ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Costanzini","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Ferrara , Vai Borsari 46, 44121, Ferrara ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Casabianca","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, SS Annunziata Hospital , Via Vicini 2, 44042, Cento (Ferrara) ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Caio","sequence":"additional","affiliation":[{"name":"Centre for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara , Via Borsari 46, 44121, Ferrara ,","place":["Italy"]},{"name":"Department of Translational Medicine, University of Ferrara , Vai Borsari 46, 44121, Ferrara ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6737-0685","authenticated-orcid":false,"given":"Gianni","family":"Testino","sequence":"additional","affiliation":[{"name":"Unit of Addiction and Hepatology, ASL3 c\/o Ospedale Policlinico San Martino , Largo Benzi 10, 16132, Genova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-9946","authenticated-orcid":false,"given":"Giovanni","family":"Addolorato","sequence":"additional","affiliation":[{"name":"Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS Largo Gemelli 8, 00168 , Rome ,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences, Universit\u00e0 Cattolica di Roma , Largo Gemelli 8, 00168, Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"De Giorgio","sequence":"additional","affiliation":[{"name":"Centre for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara , Via Borsari 46, 44121, Ferrara ,","place":["Italy"]},{"name":"Department of Internal Medicine, SS Annunziata Hospital , Via Vicini 2, 44042, Cento (Ferrara) ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"2026080608064700600_ref1","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1016\/S0140-6736(07)61814-5","article-title":"Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study","volume":"370","author":"Addolorato","year":"2007","journal-title":"Lancet"},{"key":"2026080608064700600_ref2","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1080\/14740338.2020.1709821","article-title":"Post-marketing and clinical safety experience with sodium oxybate for the treatment of alcohol withdrawal syndrome and maintenance of abstinence in alcohol-dependent subjects","volume":"19","author":"Addolorato","year":"2020","journal-title":"Expert Opin Drug Saf"},{"key":"2026080608064700600_ref3","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/S2215-0366(18)30303-1","article-title":"Baclofen for the treatment of alcohol use disorder: the Cagliari Statement","volume":"5","author":"Agabio","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"2026080608064700600_ref4","doi-asserted-by":"publisher","first-page":"CD012557","DOI":"10.1002\/14651858.CD012557.pub3","article-title":"Baclofen for alcohol use disorder","volume":"2023","author":"Agabio","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"2026080608064700600_ref5","volume-title":"L\u2019ANSM octroie une autorisation de mise sur le march\u00e9 pour une utilisation du baclof\u00e8ne dans l\u2019alcoolo-d\u00e9pendance\u2014communiqu\u00e9.","author":"Agence nationale de s\u00e9curit\u00e9 des m\u00e9dicaments et des produits de sant\u00e9 (ANSM)","year":"2018"},{"key":"2026080608064700600_ref6","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"1994","edition":"4"},{"key":"2026080608064700600_ref7","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2000"},{"key":"2026080608064700600_ref8","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"DSM-5 Task Force. 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