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Question answered:04/02/08 Warning! this question is over two years old.
We found no information concerning the suitability of prescribing acamprosate to a patient with abnormal liver function tests, namely alanine aminotransferase, and thus would advise contact a local specialist for advice or the manufacturers of this medication (see below).
The CKS guideline on problem drinking lists the following contraindications to prescribing acamprosate:
• “Acamprosate should not be used in the following circumstances [ABPI Medicines Compendium, 2003]:
o The person is a pregnant or breastfeeding woman.
o There is severe renal insufficiency (serum creatinine < 120 micromoles/L).
o There is severe hepatic failure (Childs-Pugh classification C).” [1]
The same information is given in the SPC on Campral EC (acamprosate calcium). [2]
GPNotebook offers the following information on the Childs-Pugh classification scheme:
The Child- Pugh classification is a means of assessing the severity of liver cirrhosis.
Score 1 2 3
bilirubin (micromol/l) <34 34-50 >50
albumin (g/l) >35 28-35 <28
PT (s prolonged) <4 4-6 >6
encephalopathy none mild marked
ascites none mild marked
If there is primary biliary cirrhosis or sclerosing cholangitis then bilirubin is classified as <68=1; 68-170=2; >170=3.
The individual scores are summed and then grouped as:
• <7 = A
• 7-9 = B
• >9 = C
A C classification forecasts a survival of less than 12 months.” [3]
As mentioned above, we found no guidelines or studies discussing ALT levels in relation to prescribing acamprosate and thus would suggest contacting the pharmaceutical company for further assistance:
Merck Serono
Medical Information direct line: +44 (0)208 818 7373
Medical Information e-mail: medinfo.uk@merckserono.net
References
1. CKS. Alcohol – problem drinking. May 2007. (http://www.cks.library.nhs.uk/alcohol_problem_drinking/)
2. SPC for Campral EC. November 2007. (http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=1042_)
3. GPNotebook. Child’s classification (liver cirrhosis). (http://www.gpnotebook.co.uk/simplepage.cfm?ID=201719830)
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