From the Guidelines
Acamprosate should be used to maintain abstinence in patients with alcohol dependence, as it has been shown to be effective in reducing relapse rates, particularly when combined with counseling and support programs 1. The standard dosage of acamprosate is typically 666 mg taken three times daily, though this may be adjusted to 333 mg three times daily for patients weighing less than 60 kg or those who cannot tolerate the full dose. Some key points to consider when using acamprosate include:
- It works by restoring the balance between excitatory and inhibitory neurotransmitters in the brain that becomes disrupted during chronic alcohol use, particularly affecting glutamate and GABA systems 1.
- The medication should be started as soon as possible after alcohol detoxification and continued even if relapse occurs.
- It's most effective when combined with counseling and support programs, as recommended by guidelines for managing alcohol dependence 1.
- Common side effects include diarrhea, nausea, abdominal pain, and headache.
- Acamprosate is contraindicated in patients with severe renal impairment and requires dose adjustment for moderate renal impairment.
- Unlike some other medications for alcohol dependence, acamprosate does not cause adverse reactions if alcohol is consumed while taking it. Overall, the use of acamprosate in patients with alcohol dependence can help reduce relapse rates and improve outcomes, particularly when used in conjunction with other evidence-based treatments.
From the FDA Drug Label
There are no adequate and well controlled studies in pregnant women. Acamprosate calcium delayed-release tablets should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus A study conducted in pregnant mice that were administered acamprosate calcium by the oral route starting on Day 15 of gestation through the end of lactation on postnatal day 28 demonstrated an increased incidence of still-born fetuses at doses of 960 mg/kg/day or greater (approximately 2 times the MRHD oral dose on a mg/m2 basis) No effects were observed at a dose of 320 mg/kg/day (approximately one-half the MRHD dose on a mg/m2 basis).
Acamprosate Use in Pregnancy:
- The FDA drug label does not provide enough information to fully assess the safety of acamprosate in human pregnancy.
- Animal studies suggest potential risks, but human data is limited.
- Key Considerations:
- No adequate and well-controlled studies in pregnant women.
- Potential risk to the fetus cannot be ruled out.
- Use during pregnancy only if the potential benefit justifies the potential risk to the fetus 2
From the Research
Overview of Acamprosate
- Acamprosate, also known as Campral, is a medication used to maintain abstinence in patients with alcohol dependence following alcohol withdrawal 3, 4.
- It is one of the limited number of pharmacological treatment options approved as an adjunct to psychosocial interventions to facilitate the maintenance of abstinence in alcohol-dependent patients 4.
Efficacy of Acamprosate
- Studies have shown that acamprosate is effective in improving various key outcomes, including the proportion of patients who maintained complete abstinence from alcohol, the mean cumulative abstinence duration, the percentage of alcohol-free days, and the median time to first drink 3, 4.
- Acamprosate has been found to be more effective in preventing a lapse, whereas naltrexone is better in preventing a lapse from becoming a relapse 5.
- The combination of acamprosate and naltrexone has been described as a reasonable treatment option that is safe and effective in clinical studies 6.
Comparison with Naltrexone
- Naltrexone and acamprosate have been compared in several studies, with results showing that naltrexone is more effective in preventing heavy drinking, while acamprosate is more effective in supporting abstinence 7, 5.
- A meta-analysis found that naltrexone had a significant effect on the maintenance of abstinence as well as the prevention of heavy drinking, while acamprosate was shown only to support abstinence 5.