Acamprosate should not be given in which impairment?

• A. Renal impairment
• B. Hepatic impairment
• C. Cardiac impairment
• D. Pulmonary impairment

Answer: (A)

Acamprosate is cleared by the kidneys and is not significantly metabolized by the liver. Because its elimination depends on renal function, significant renal impairment allows the drug to accumulate and raises the risk of adverse effects. For this reason, it should not be given in substantial renal impairment (and is often avoided in severe renal impairment or in dialysis). Hepatic impairment doesn’t usually affect acamprosate clearance since it’s excreted unchanged by the kidneys, so hepatic dysfunction is not a contraindication. Cardiac or pulmonary impairment don’t impact its clearance, so they aren’t the reason for avoiding the medication.