What is the use of Campral (acamprosate) in treating alcohol dependence?

Acamprosate for Treating Alcohol Dependence

Acamprosate is the only intervention with sufficient high-quality evidence to be recommended for maintaining abstinence in detoxified alcohol-dependent patients. 1

Indication and Mechanism

• Acamprosate (Campral) is specifically indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are already abstinent at treatment initiation 2
• It acts by modulating the glutamatergic neurotransmitter system to counteract the imbalance between glutamatergic and GABAergic systems caused by chronic alcohol exposure 3
• Acamprosate has structural similarities to the inhibitory neurotransmitter GABA and the neuromodulator taurine 3

Efficacy Evidence

• Acamprosate demonstrates superior efficacy compared to placebo with moderate certainty evidence (odds ratio 1.86,95% confidence interval 1.49 to 2.33), increasing the absolute probability of abstinence from 25% to 38% 1
• It is more effective in maintaining abstinence rather than inducing remission, making it most appropriate for patients who have already completed detoxification 1
• Acamprosate shows better patient retention than placebo with moderate certainty evidence (odds ratio 0.73,0.62 to 0.86), reducing dropout rates from 50% to 42% 1
• Weak evidence suggests acamprosate might be effective in the longer term (beyond 12 months), though more research is needed 1

Clinical Application

• Treatment with acamprosate must be part of a comprehensive management program that includes psychosocial support 2
• Acamprosate is particularly valuable for patients with hepatic impairment or liver disease as it does not require dosage adjustment in mild to moderate hepatic impairment 3, 4
• Dosage adjustments or contraindications are recommended for patients with renal impairment 4
• Acamprosate has a low propensity for drug interactions, making it safer to use with other medications 4

Comparison with Other Medications

• While naltrexone and disulfiram are also approved for alcohol dependence, there is insufficient high-quality evidence to conclude they improve abstinence in detoxified patients 1
• Naltrexone may be more effective in preventing relapse after a lapse, while acamprosate is more effective in maintaining complete abstinence 3
• Limited data suggest that combination therapy with acamprosate and naltrexone may provide better efficacy than acamprosate monotherapy alone 3

Treatment Considerations

• Patient motivation significantly impacts treatment outcomes - acamprosate appears more effective in patients who have a baseline goal of abstinence 5
• The standard dose is 2g daily, though some studies have explored a 3g dose with potentially greater effects 5
• Acamprosate is generally well tolerated with few serious adverse effects 5, 4

Limitations and Caveats

• Despite being the best-evidenced option, acamprosate still shows modest overall effectiveness in the long-term maintenance of recovery from alcohol dependence 6
• Treatment should be initiated only after the patient has achieved abstinence, as it has not been shown to have significant impact on alcoholics who have not been detoxified 1
• Complete abstinence should be the goal, as there is a significant risk of recidivism in patients who attempt to cut back but not stop drinking altogether 1