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Nalmefene — MRCPsych Paper B MCQ

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HardSubstance MisuseNalmefeneMRCPsych Paper B

A 50-year-old man with alcohol dependence wants to reduce his alcohol consumption rather than become abstinent. At initial assessment, he reports drinking approximately 75 g of alcohol per day. He has no physical withdrawal symptoms and does not require immediate detoxification. Continuous psychosocial support focused on reducing alcohol consumption is started. At review 2 weeks later, he is still drinking approximately 68 g per day. Which statement best describes the use of nalmefene in accordance with its marketing authorisation and NICE TA325?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — It may now be initiated alongside continuous psychosocial support because his high drinking risk level has persisted.

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

B is correct. For men, a high drinking risk level is alcohol consumption above 60 g/day. Nalmefene may be initiated when this level persists 2 weeks after initial assessment, provided there are no physical withdrawal symptoms and no requirement for immediate detoxification. It must be combined with continuous psychosocial support focused on adherence and reducing consumption. Starting it at the initial assessment is therefore inappropriate. Intake need not exceed 100 g/day; that threshold denotes a very high rather than merely high risk level. Nalmefene is intended to reduce consumption, not to manage assisted withdrawal or maintain complete abstinence, and it is not licensed as unsupported monotherapy.

Reference: NICE technology appraisal guidance TA325, "Nalmefene for reducing alcohol consumption in people with alcohol dependence", recommendation 1.1, 2014 (reviewed 2018): https://www.nice.org.uk/guidance/ta325/chapter/1-Recommendations