From the Guidelines
Campral (acamprosate) is the only intervention with enough high-quality evidence to conclude that it is better at maintaining alcohol abstinence than placebo. It works by restoring the balance between excitatory and inhibitory neurotransmitters in the brain that becomes disrupted during chronic alcohol use and withdrawal 1. The standard dosage is 666 mg (two 333 mg tablets) taken three times daily, regardless of meals. Patients should continue taking Campral even if they relapse, as it can still help reduce drinking. Treatment typically continues for 6-12 months, though some patients may benefit from longer therapy.
Some key points to consider when using Campral include:
- It does not cause adverse reactions if alcohol is consumed, unlike disulfiram, and it doesn't reduce cravings like naltrexone does 1.
- Instead, it specifically helps normalize brain chemistry disrupted by alcohol dependence.
- Campral is generally well-tolerated with diarrhea being the most common side effect, and it's safe for patients with liver disease 1.
- However, the dose needs adjustment in patients with kidney impairment.
- For best results, Campral should be used as part of a comprehensive treatment program that includes counseling and support groups.
The most recent and highest quality study, a systematic review and network meta-analysis published in the BMJ in 2020, found that 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. This study provides strong evidence for the effectiveness of Campral in maintaining abstinence in alcohol-dependent individuals.
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. Treatment with acamprosate calcium delayed-release tablets should be part of a comprehensive management program that includes psychosocial support.
The role of Campral (acamprosate) in treating alcohol dependence is to maintain abstinence from alcohol in patients who are already abstinent at the start of treatment. It is intended to be used as part of a comprehensive management program that includes psychosocial support 2, 2.
- Key points:
- Campral is used for maintenance of abstinence, not for achieving initial abstinence.
- It should be used in conjunction with psychosocial support.
- The efficacy of Campral in promoting abstinence has not been demonstrated in subjects who have not undergone detoxification and achieved alcohol abstinence prior to beginning treatment 2.
From the Research
Role of Campral (Acamprosate) in Treating Alcohol Dependence
- Campral (acamprosate) is a pharmacological treatment approved by the Food and Drug Administration (FDA) for alcohol dependence, which works by promoting a balance between excitatory and inhibitory neurotransmitters, glutamate and gamma-aminobutyric acid, respectively 3.
- The exact mechanism of action of acamprosate is still under investigation, but it appears to help individuals with alcohol dependence by reducing withdrawal-associated distress 3, 4.
- Acamprosate has demonstrated its efficacy in more than 25 placebo-controlled, double-blind trials for individuals with alcohol dependence, and has generally been found to be more efficacious than placebo in significantly reducing the risk of returning to any drinking and increasing the cumulative duration of abstinence 3, 5.
Efficacy and Safety of Campral
- Acamprosate has been found to be effective in maintaining complete abstinence in detoxified alcohol-dependent patients, irrespective of disease severity or the type of psychosocial support 4, 6.
- The drug has a low bioavailability, but also has an excellent tolerability and safety profile, with diarrhea being the most common adverse effect accompanying acamprosate therapy 3, 6.
- Acamprosate may be particularly useful in those with hepatic impairment and/or liver disease, as it is not metabolized by the liver and is not impacted by alcohol use 3, 4.
Comparison with Other Treatments
- Acamprosate appears to be no more efficacious than placebo in reducing heavy drinking days, and its efficacy does not appear to be improved by combining it with other active medications or with psychosocial treatment 3.
- Acamprosate has similar efficacy to naltrexone, and the combination of acamprosate and naltrexone appears to be more efficacious than acamprosate alone, when combined with psychosocial interventions 6, 5.
- A meta-analysis showed that alcohol-consumption outcomes were similarly improved with acamprosate or naltrexone 5.
Reduction of Craving for Alcohol
- A pilot study found that acamprosate may play a role in reduction of craving for alcohol after 6 weeks of treatment, as measured by a contextual priming task with alcohol and neutral words and craving questionnaires 7.