What is the recommended dose of acamprosate (Campral) for maintaining abstinence in alcohol-dependent patients?

Acamprosate Dosing for Alcohol Dependence

The recommended dose of acamprosate is 666 mg (two 333 mg tablets) three times daily for patients weighing ≥60 kg, with dose reduction to one-third less (1332 mg daily total) for patients weighing <60 kg. 1

Standard Dosing Algorithm

For patients ≥60 kg:

• 666 mg (two 333 mg tablets) three times daily
• Total daily dose: 1998 mg 1

For patients <60 kg:

• Reduce dose by one-third
• 1332 mg daily total (typically 333 mg tablets, dosing adjusted accordingly) 2

For moderate renal impairment (CrCl 30-50 mL/min):

• 333 mg three times daily 2, 1

For severe renal impairment (CrCl ≤30 mL/min):

• Acamprosate is contraindicated 1

Critical Timing Considerations

Acamprosate must be initiated 3-7 days after the last alcohol consumption and only after withdrawal symptoms have completely resolved. 2 Starting too early reduces efficacy since acamprosate maintains abstinence rather than induces it. 3, 2

The FDA label confirms treatment should be initiated "as soon as possible after the period of alcohol withdrawal, when the patient has achieved abstinence." 1

Treatment Duration

• Typical treatment period: 3-6 months 2
• Can extend up to 12 months for optimal results 2
• Continue treatment even if patient relapses 1

Administration Details

• Dosing may be done without regard to meals, though dosing with meals was used in clinical trials and is suggested for patients who regularly eat three meals daily 1
• Steady-state plasma concentrations are reached after 5-7 days of repeated dosing 4
• The enteric-coated formulation should not be crushed 1

Essential Caveats

Acamprosate is not effective for inducing abstinence or treating acute withdrawal. 3 Patients must be detoxified first, with a number needed to treat of 12 to prevent relapse. 3

Must be combined with comprehensive psychosocial treatment programs - using acamprosate without psychosocial support is a common pitfall that reduces efficacy. 3, 2, 1

Safety Profile Advantages

Acamprosate is particularly safe for patients with liver disease as it carries no risk of hepatotoxicity and is not metabolized by the liver. 3, 2 This makes it the preferred agent in patients with alcohol-associated liver disease according to the American Association for the Study of Liver Diseases. 3

The most common adverse effect is diarrhea, which is generally mild and transient. 1, 5