Alcohol Relapse Prevention — MRCPsych Paper B MCQ

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HardSubstance MisuseAlcohol Relapse PreventionMRCPsych Paper B

A 44-year-old man with alcohol dependence has completed assisted withdrawal and remains abstinent. He has acute alcoholic hepatitis, normal renal function and no current or recent opioid use. Under the UK Summary of Product Characteristics, which medication used for alcohol-relapse prevention is specifically contraindicated because of the acute hepatitis?

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Correct answer: C — Naltrexone

Naltrexone is the single best answer. Its UK SmPC specifically lists acute hepatitis and liver failure as contraindications and advises caution and monitoring in lesser hepatic impairment. Acamprosate is mainly renally eliminated; renal impairment is its principal organ-function contraindication, although evidence is insufficient in Child-Pugh C liver insufficiency. Disulfiram can cause serious drug-induced liver injury and requires caution and liver-function monitoring in reduced hepatic function, but acute hepatitis is not listed as a formal contraindication in the cited UK SmPC. Thiamine prevents or treats deficiency-related complications rather than preventing alcohol relapse. Nalmefene is intended to reduce consumption in people who continue to drink at a high-risk level, not to maintain immediate abstinence after withdrawal.

Reference: electronic Medicines Compendium. Adepend 50 mg film-coated tablets: Summary of Product Characteristics, sections 4.1, 4.3 and 4.4; last updated 16 January 2020. https://www.medicines.org.uk/emc/product/3559/smpc