A 28-year-old woman with severe alcohol use disorder and decompensated cirrhosis (Child-Pugh class C) requires pharmacotherapy for relapse prevention. Which agent is preferred in this patient?
- A Disulfiram
- B Acamprosate ✓
- C Naltrexone
- D Topiramate
Correct answer: B. Acamprosate
Explanation
Acamprosate is renally excreted and is the preferred agent in patients with severe hepatic impairment. Both naltrexone and disulfiram are hepatically metabolized and are contraindicated or require caution in severe liver disease. Naltrexone carries a warning for hepatotoxicity, and disulfiram is hepatically metabolized with its own risk of hepatotoxicity. Acamprosate has no hepatic metabolism.
Reference: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 10th ed.
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