What is your approach to initiating naltrexone in patients with alcohol use disorder and co-occurring liver disease?

It is widely accepted that if liver enzymes are 3x above the normal limit, it is not advised to start naltrexone. Between 1-3x the upper limit, one has to do a pro and con analysis of whether the benefits of alcohol cessation would outweigh potential liver toxicity from naltrexone. Further, naltrexo...