What is the recommended dosing schedule for Campral (Acamprosate) in a patient with alcohol dependence and potentially impaired renal function?

Campral (Acamprosate) Dosing Schedule

Campral should be taken as two 333 mg tablets (666 mg total) three times daily, preferably with meals, for a total daily dose of 1998 mg. 1

Standard Dosing Regimen

• Take 666 mg (two 333 mg tablets) three times daily - morning, midday, and evening 1
• Dosing with meals is suggested for patients who regularly eat three meals daily, though it can be taken without regard to meals 1
• Steady-state plasma concentrations are reached within 5-7 days of starting treatment 2, 1

Timing of Initiation

Critical: Do not start Campral immediately after sobering up. 2, 3

• Initiate treatment 3-7 days after the last alcohol consumption, only after withdrawal symptoms have completely resolved 2, 3, 1
• The patient must be detoxified and abstinent before starting acamprosate 2, 3
• Starting too early reduces efficacy since acamprosate maintains abstinence rather than inducing it 3

Dose Adjustments

For Body Weight

• Patients weighing <60 kg: Reduce dose by one-third to 1332 mg/day (one 333 mg tablet taken three times daily) 2, 3
• Patients weighing ≥60 kg: Use full dose of 1998 mg/day 2

For Renal Impairment

• Moderate renal impairment (CrCl 30-50 mL/min): Reduce to 333 mg three times daily 1
• Severe renal impairment (CrCl ≤30 mL/min): Contraindicated - do not use 1

Treatment Duration

• Typical treatment period is 3-6 months, though it can extend up to 12 months 2, 3
• Continue treatment even if the patient relapses to drinking 1
• Acamprosate should be part of a comprehensive psychosocial treatment program 1

Safety Considerations in Liver Disease

• Acamprosate is the preferred agent in patients with alcohol-associated liver disease because it carries no risk of hepatotoxicity and is not metabolized by the liver 4, 2
• No dose adjustment is needed for hepatic impairment 4, 1
• Unlike naltrexone and disulfiram, which are contraindicated or should be avoided in severe liver disease, acamprosate remains safe 4, 2

Common Pitfalls to Avoid

• Do not start immediately after detoxification - wait 3-7 days until withdrawal has resolved 2, 3
• Do not use as monotherapy - always combine with psychosocial support 3, 1
• Do not discontinue prematurely - continue for at least 3-6 months for optimal results 2, 3
• Do not forget to adjust dose for patients <60 kg or with moderate renal impairment 2, 1