What is the recommended dose of acamprosate (Campral) for treating chronic alcoholism?

Recommended Dosage of Acamprosate for Chronic Alcoholism

The recommended dose of acamprosate for treating chronic alcoholism is 666 mg (two 333 mg tablets) taken three times daily, for a total daily dose of 1,998 mg. 1

Dosing Regimen

• Acamprosate should be taken as two 333 mg tablets three times daily (total daily dose: 1,998 mg) 2, 1
• For patients weighing less than 60 kg, the dose should be reduced to 1.3 g/day (approximately one-third less) 3, 4
• Dosing can be done with or without meals, though taking it with meals was employed during clinical trials 1

Timing of Initiation

• Treatment should be initiated as soon as possible after alcohol withdrawal, when the patient has achieved abstinence 1
• Ideally, acamprosate should be started 3-7 days after the last alcohol consumption and only after withdrawal symptoms have resolved 3
• Starting acamprosate too early may reduce its efficacy since it works best for maintaining abstinence rather than inducing it 3

Duration of Treatment

• The typical treatment period is 3-6 months, but can extend up to 12 months 3
• Treatment should be maintained even if the patient relapses 1

Special Populations and Considerations

• For patients with moderate renal impairment (creatinine clearance 30-50 mL/min), the dose should be reduced to one 333 mg tablet three times daily 1
• Acamprosate is contraindicated in patients with severe renal impairment (creatinine clearance ≤30 mL/min) 1
• Unlike naltrexone, acamprosate is not metabolized by the liver, making it suitable for patients with alcoholic liver disease 3, 2

Mechanism and Efficacy

• Acamprosate works as an NMDA receptor antagonist with structural similarities to GABA 2, 3
• It reduces withdrawal symptoms and alcohol craving, with its effect more pronounced in maintaining rather than inducing remission 2, 3
• The number needed to treat to prevent return to any drinking is approximately 12 for acamprosate 2

Common Pitfalls to Avoid

• Failing to combine acamprosate with psychosocial support, which is recommended in all guidelines 3, 1
• Discontinuing treatment prematurely - acamprosate should be continued for the recommended duration for optimal results 3
• Not adjusting dosage for patients with renal impairment or low body weight 1, 3
• Starting treatment before complete detoxification, which may reduce efficacy 3

Pharmacokinetics

• Acamprosate reaches steady-state after 5-7 days of regular administration 4
• It has a moderate distribution volume of about 20L and is not protein bound or metabolized 4
• Half of acamprosate is eliminated unchanged in urine, with the other half possibly eliminated through biliary excretion 4