What is the relationship between Campral (Acamprosate) and chronic conditions?

From the Guidelines

Campral (Acamprosate) is recommended for maintaining abstinence from alcohol in patients with chronic conditions, specifically those with alcohol dependence, as it has been shown to be effective in supporting detoxified patients to maintain abstinence for up to 12 months. The relationship between Campral and chronic conditions is primarily focused on its use in treating alcohol dependence, which can have a significant impact on various chronic conditions, such as alcoholic liver disease (ALD). According to a systematic review and network meta-analysis published in the BMJ in 2020 1, acamprosate was found to be the only intervention with enough high-quality evidence to conclude that it is better at maintaining alcohol abstinence than placebo.

The use of acamprosate in patients with chronic conditions, such as ALD, is supported by several studies. A study published in Hepatology in 2020 1 found that acamprosate does not appear to be toxic to the liver and is probably safe, making it a viable option for patients with ALD. Another study published in the Journal of Hepatology in 2012 1 found that acamprosate is a modulator of the glutamatergic receptor system and has been shown to be effective in reducing alcohol consumption.

In terms of specific chronic conditions, acamprosate has been studied in patients with ALD. A study published in Clinical and Molecular Hepatology in 2013 1 found that baclofen and acamprosate can be used to achieve alcohol abstinence in patients with ALD. However, it is essential to note that acamprosate has not been extensively studied in patients with other chronic conditions, and its use in these populations should be approached with caution.

Some key points to consider when using acamprosate in patients with chronic conditions include:

• Acamprosate is specifically designed to help maintain abstinence from alcohol in people with alcohol dependence by restoring brain chemical balance.
• It has no known therapeutic effect on other chronic conditions, such as inflammatory bowel disease, and should not be used as a treatment for these conditions.
• Acamprosate has been shown to be safe and effective in patients with ALD, but its use in other chronic conditions should be approached with caution.
• Patients with chronic conditions should consult with a healthcare professional to develop a personalized treatment plan that takes into account their specific condition, symptoms, and overall health status.

Overall, acamprosate is a valuable treatment option for patients with alcohol dependence, particularly those with chronic conditions such as ALD, and should be considered as part of a comprehensive treatment plan 1.

From the FDA Drug Label

The pharmacokinetics of acamprosate calcium delayed-release tablets have not been evaluated in a geriatric population However, since renal function diminishes in elderly patients and acamprosate is excreted unchanged in urine, acamprosate plasma concentrations are likely to be higher in the elderly population compared to younger adults. Peak plasma concentrations after administration of a single dose of 2 x 333 mg acamprosate calcium delayed-release tablets to patients with moderate or severe renal impairment were about 2-fold and 4-fold higher, respectively, compared to healthy subjects. A dose of 1 x 333 mg acamprosate calcium delayed-release tablets, three times daily, is recommended in patients with moderate renal impairment (creatinine clearance of 30-50 mL/min, [see Use in Specific Populations (8.6)]. Acamprosate calcium delayed-release tablets are contraindicated in patients with severe renal impairment (creatinine clearance of ≤ 30 mL/min)

The relationship between Campral (Acamprosate) and chronic conditions is that patients with certain chronic conditions, such as:

• Renal impairment: may require dose adjustments or are contraindicated due to increased plasma concentrations of acamprosate.
• Geriatric population: may have higher acamprosate plasma concentrations due to decreased renal function. It is essential to consider these factors when prescribing Campral to patients with chronic conditions 2.

From the Research

Relationship Between Campral (Acamprosate) and Chronic Conditions

• Campral (Acamprosate) is indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation in combination with psychosocial support 3.
• The drug has been consistently associated with greater beneficial effects on measures of alcohol abstinence compared with placebo, including greater rates of complete abstinence, longer times to first drink, and increased duration of cumulative abstinence 3, 4.
• Acamprosate has been found to be effective in maintaining abstinence in detoxified alcohol-dependent patients, irrespective of disease severity or the type of psychosocial support 5.
• The drug may be particularly useful in those with hepatic impairment and/or liver disease, as it is not metabolized by the liver and can be administered to patients with hepatitis or liver disease 6, 5.
• Acamprosate has been shown to be safe in patients with hepatic impairment, but a dose reduction is recommended in patients with renal impairment 7.
• The most common adverse events associated with acamprosate are diarrhea and flatulence, which are generally reported as transient and mild or moderate in severity 7.

Efficacy in Chronic Conditions

• Acamprosate has demonstrated efficacy in reducing the risk of returning to any drinking and increasing the cumulative duration of abstinence in individuals with alcohol dependence 6.
• The drug has been found to be more efficacious than placebo in significantly reducing the risk of returning to any drinking, but appears to be no more efficacious than placebo in reducing heavy drinking days 6.
• Acamprosate has been shown to have similar efficacy to naltrexone, and combination therapy with these two agents may provide better efficacy than acamprosate monotherapy 5.

Safety and Tolerability

• Acamprosate has been found to be well tolerated, with a low propensity for drug interactions, and can be used safely in alcohol-dependent patients, including those taking concomitant medications, or having renal or hepatic impairment 4, 7.
• The majority of adverse events associated with acamprosate are reported as transient and considered "mild" or "moderate" in severity, and discontinuation rates due to adverse events are comparable to placebo 7.