Campral (Acamprosate) Initiating Dose
The standard initiating dose of Campral is 666 mg (two 333 mg tablets) taken three times daily, for a total daily dose of 1998 mg (approximately 2 grams per day). 1
Standard Dosing Protocol
- Start with 666 mg three times daily immediately after the patient achieves abstinence following alcohol withdrawal 1
- Dosing can be done without regard to meals, though taking it with meals may be preferred if the patient regularly eats three meals daily 1
- Treatment should be initiated as soon as possible after the alcohol withdrawal period when abstinence has been achieved 1
Dose Modifications for Renal Impairment
Moderate renal impairment (creatinine clearance 30-50 mL/min):
- Reduce starting dose to 333 mg three times daily (one tablet per dose) 1
Severe renal impairment (creatinine clearance ≤30 mL/min):
- Acamprosate is contraindicated and should not be used 1
Clinical Context and Safety Profile
- Acamprosate has no hepatic metabolism and is renally excreted, making it particularly advantageous in patients with liver disease 2
- The American Association for the Study of Liver Diseases notes that acamprosate has no reported instances of hepatotoxicity, unlike naltrexone and disulfiram which undergo hepatic metabolism 2
- Treatment must be part of a comprehensive psychosocial support program 1
- The drug should be continued even if the patient relapses to alcohol use 1
Important Prescribing Considerations
- Acamprosate is only effective in patients who have already achieved abstinence prior to starting treatment—it has not been shown to help patients who have not undergone detoxification 1
- Steady-state plasma concentrations are reached after 5-7 days of treatment 3
- The medication is not metabolized and is excreted unchanged in urine 3
- Food decreases absorption, but this does not require dose adjustment 3