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Acamprosate Renal Safety — MRCPsych Paper B MCQ

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ModerateSubstance MisuseAcamprosate Renal SafetyMRCPsych Paper B

A 52-year-old man with alcohol dependence has completed assisted withdrawal. He has compensated alcohol-related cirrhosis (Child-Pugh B) and normal renal function. Acamprosate is being considered to support abstinence. Which pharmacokinetic property most supports its use in this patient?

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Reveal the answer and explanation

Correct answer: B — It is not significantly metabolised and is excreted in the urine

Explanation lettering: C = shown as A · A = shown as C

B is correct. Acamprosate is not significantly metabolised and is eliminated in the urine. Its pharmacokinetics are not altered in Child-Pugh A or B hepatic impairment, which supports its use in compensated liver disease when renal function is normal. This does not make it universally safe: its elimination depends on renal function, and the cited SmPC contraindicates it in renal impairment; safety and efficacy are also not established in Child-Pugh C disease. Options A and C incorrectly describe hepatic metabolism or biliary elimination. Option D is the reverse of the relevant renal limitation. Acamprosate supports abstinence through effects on neurotransmission and does not directly reverse hepatic fibrosis, so E is incorrect.

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