From the Guidelines
Acamprosate therapy can be initiated after the patient has completed acute alcohol withdrawal and detoxification, typically 5 to 7 days after stopping drinking alcohol, as it has been found to be effective in maintaining abstinence from alcohol compared to placebo 1. When considering the initiation of acamprosate therapy, it is crucial to evaluate the patient's medical stability and commitment to abstinence. The medication is not intended to treat withdrawal symptoms but rather to help maintain abstinence from alcohol. Key considerations for initiating acamprosate therapy include:
- The patient must have already completed acute alcohol withdrawal and detoxification
- The patient should be medically stable and committed to abstinence
- Acamprosate is most effective when combined with counseling and support groups as part of a comprehensive treatment plan for alcohol use disorder
- The standard dosage is 666 mg taken three times daily, though this may be adjusted based on body weight or kidney function According to the most recent and highest quality study, acamprosate is the only intervention with enough evidence to conclude that it is better than placebo in supporting detoxified, alcohol-dependent patients to maintain abstinence for up to 12 months 1.
From the FDA Drug Label
• Acamprosate calcium delayed-release tablets are indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation (1, 2).
• Treatment with acamprosate calcium delayed-release tablets should be part of a comprehensive management program that includes psychosocial support (1)
Acamprosate (Campral) therapy can be initiated in patients with alcohol dependence who are abstinent at treatment initiation.
From the Research
Initiation of Acamprosate Therapy
Acamprosate (Campral) therapy can be initiated after detoxification. The studies suggest that starting acamprosate after detoxification is completed is associated with better drinking outcomes during subsequent alcohol rehabilitation treatment 3.
Key Findings
- Acamprosate is effective in maintaining abstinence in alcohol-dependent patients after detoxification 4, 5, 6.
- The efficacy of acamprosate appears to be dose-dependent and enhanced by the addition of disulfiram 4.
- Acamprosate is generally well tolerated, with the most common adverse events being gastrointestinal or dermatological 4, 5.
- Starting acamprosate at the beginning of detoxification did not improve outcomes during the detoxification phase 3.
Considerations for Initiation
- Acamprosate can be used as an adjunct to psychosocial/behavioural therapies to facilitate the maintenance of abstinence in alcohol-dependent patients 4, 5.
- The use of acamprosate as an adjunct to psychosocial interventions in alcohol-dependent patients provides modest but potentially valuable improvements in alcohol-consumption outcomes 5.
- Patient motivation is an important factor in the effectiveness of acamprosate, with greater effects seen in patients with a baseline goal of abstinence 7.