What is the recommended dose of acamprosate (acamprosate calcium) for a patient with alcohol-induced psychosis and impaired renal function?

Dosing of Acamprosate in Alcohol-Induced Psychosis with Impaired Renal Function

For patients with alcohol-induced psychosis and moderate renal impairment (creatinine clearance 30-50 mL/min), the recommended dose of acamprosate is one 333 mg tablet taken three times daily. 1

Dosing Guidelines Based on Renal Function

The appropriate dosing of acamprosate depends primarily on the patient's level of renal impairment:

• Normal renal function: Standard dose is two 333 mg tablets (666 mg) taken three times daily 1
• Moderate renal impairment (CrCl 30-50 mL/min): Reduced dose of one 333 mg tablet taken three times daily 1
• Severe renal impairment (CrCl ≤30 mL/min): Acamprosate is contraindicated 1

Pharmacokinetic Considerations

Acamprosate is not metabolized by the liver and is excreted unchanged in the urine, making renal function the critical factor in dosing decisions 1, 2. In patients with moderate renal impairment, peak plasma concentrations can be approximately 2-fold higher than in healthy subjects, with elimination half-life about 1.8-fold longer 1. This necessitates the dose reduction to prevent drug accumulation.

Administration Recommendations

• Treatment should be initiated as soon as possible after alcohol withdrawal when the patient has achieved abstinence 1
• Although dosing may be done without regard to meals, taking acamprosate with meals was employed during clinical trials 1
• For patients who regularly eat three meals daily, dosing with meals is suggested 1

Treatment Duration and Monitoring

• Acamprosate should be maintained if the patient relapses 1
• Regular monitoring of renal function is essential to ensure appropriate dosing continues
• Treatment should be part of a comprehensive management program that includes psychosocial support 1

Efficacy in Alcohol-Induced Psychosis

Acamprosate is effective for maintaining abstinence from alcohol, which is crucial for patients with alcohol-induced psychosis 3. The medication works by helping to restore the balance between excitatory and inhibitory neurotransmission that becomes dysregulated with chronic alcohol use 2.

Important Considerations and Precautions

• Acamprosate does not produce withdrawal symptoms and does not cause alcohol aversion or disulfiram-like reactions 1
• The medication contains sodium sulfite, which may cause allergic reactions in susceptible individuals 1
• Suicidal ideation and depression should be monitored, as these events were more common in acamprosate-treated patients than in placebo-treated patients in clinical trials 1

Combination with Other Treatments

For optimal outcomes, acamprosate should be combined with psychosocial interventions such as:

• Cognitive Behavioral Therapy
• Motivational Enhancement Therapy
• Support groups

This combination approach has shown superior outcomes compared to either intervention alone 3.

Remember that the ultimate goal of treatment is alcohol abstinence, which is essential for managing alcohol-induced psychosis and preventing further deterioration of both psychiatric and renal function 4, 3.