A 50-year-old man with severe alcohol use disorder and decompensated cirrhosis (Child-Pugh C) is interested in relapse prevention. Which medication is contraindicated in this patient?

• A Acamprosate
• B Topiramate
• C Disulfiram
• D Naltrexone ✓

Explanation

Naltrexone is hepatically metabolized and can cause hepatocellular injury. It is contraindicated in patients with acute hepatitis or decompensated cirrhosis. Acamprosate is safe in liver disease but requires dose adjustment in renal impairment. Disulfiram is also hepatotoxic, but naltrexone is the most clearly contraindicated agent in decompensated cirrhosis.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

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