A 55-year-old man with alcohol use disorder and stage 4 chronic kidney disease (eGFR 20 mL/min) is being considered for acamprosate. Which is the most appropriate statement?
- A Acamprosate is contraindicated in severe renal impairment ✓
- B Acamprosate is safe without dose adjustment
- C Acamprosate requires a 50% dose reduction
- D Acamprosate is primarily hepatically metabolized
Correct answer: A. Acamprosate is contraindicated in severe renal impairment
Explanation
Acamprosate is excreted unchanged by the kidneys and is contraindicated in severe renal impairment (creatinine clearance <30 mL/min) due to accumulation and toxicity. It is not metabolized by the liver. Dose reduction is insufficient; the drug should be avoided entirely in this setting. Naltrexone is the preferred relapse prevention agent in patients with renal disease.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
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