Acamprosate Safety Liver Disease — MRCPsych Paper B MCQ

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ModerateSubstance MisuseAcamprosate Safety Liver DiseaseMRCPsych Paper B

A 55-year-old man with alcohol dependence has completed assisted withdrawal and wishes to maintain abstinence. He has compensated Child–Pugh class A alcohol-related cirrhosis and an estimated glomerular filtration rate of 90 mL/min/1.73 m². Which medication has the most favourable hepatic safety profile for relapse prevention alongside a psychological intervention?

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Correct answer: A — Acamprosate

Acamprosate has the most favourable hepatic safety profile. It is not significantly metabolised, is excreted in urine, and its pharmacokinetics are unchanged in Child–Pugh A or B hepatic impairment. The normal renal function given in the stem removes its principal prescribing limitation. Naltrexone is hepatically metabolised and requires caution and monitoring in hepatic impairment. Disulfiram can cause unpredictable drug-induced liver injury and is a less suitable choice in established liver disease. Nalmefene is used to reduce alcohol consumption in selected patients rather than as standard post-withdrawal maintenance of abstinence. Chlordiazepoxide is used for managing alcohol withdrawal, not long-term relapse prevention, and may accumulate in liver impairment.

Reference: electronic Medicines Compendium, Acamprosate 333 mg Gastro-resistant Tablets, Summary of Product Characteristics, sections 4.3, 4.4 and 5.2, updated 12 December 2025. https://www.medicines.org.uk/emc/product/2729/smpc