In alcohol use disorder deaddiction, acamprosate is preferred over disulfiram in which clinical situation?

• A Patient who has already achieved abstinence and has impaired renal function
• B Patient who is still drinking and wants to cut down gradually
• C Patient who requires short-term (2-week) intervention before elective surgery
• D Patient with severe liver disease who needs deterrent therapy ✓

Explanation

Disulfiram inhibits aldehyde dehydrogenase and is metabolised hepatically; it is contraindicated in significant hepatic impairment and portal hypertension because the disulfiram-alcohol reaction can be life-threatening and the drug itself is hepatotoxic. Acamprosate (N-acetyl homotaurine) modulates glutamate/GABA balance, reduces craving, and is renally (not hepatically) excreted — making it safer in liver disease. However, acamprosate requires established abstinence before initiation and should be avoided in severe renal failure. Naltrexone, similarly, should be used with caution in active hepatic disease.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.