Naltrexone LFT Monitoring — MRCPsych Paper B MCQ

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ModerateSubstance MisuseNaltrexone LFT MonitoringMRCPsych Paper B

A 46-year-old man with alcohol dependence has completed assisted withdrawal. He is opioid-free, and oral naltrexone is being considered alongside a psychological intervention to prevent relapse. Which baseline investigation should be performed before naltrexone is started?

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Correct answer: B — Liver function tests, including gamma-glutamyl transferase

The correct answer is B. NICE recommends a comprehensive medical assessment before oral naltrexone, including baseline liver function tests with GGT. Naltrexone is mainly metabolised by the liver, and the SmPC contraindicates it in acute hepatitis, liver failure, and severe or acute liver impairment. The SmPC advises liver-function monitoring during treatment; NICE does not recommend routine blood tests for every patient during follow-up but advises considering them in older people, people with obesity, and when monitoring hepatic recovery. An ECG, thyroid tests, prolactin and creatine kinase are relevant to selected psychotropic medicines or clinical presentations but are not standard naltrexone-specific baseline investigations. Opioid use must also be excluded before treatment because naltrexone can precipitate withdrawal.

Reference: NICE, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, CG115, recommendation 1.3.6.4, 2011 (updated 2014): https://www.nice.org.uk/guidance/cg115/chapter/Recommendations