Does Acamprosate (Campral) treat alcohol dependence?

From the Guidelines

Acamprosate (Campral®) is a recommended treatment for maintaining abstinence in patients with alcohol use disorder, with a significant increase in odds of abstinence compared to placebo, as shown in a recent systematic review and network meta-analysis 1. The standard dosage of acamprosate is 666 mg (two 333 mg tablets) taken three times daily, regardless of meals.

• Patients with moderate renal impairment require a reduced dose of 333 mg three times daily.
• Acamprosate works by restoring the balance between excitatory and inhibitory neurotransmitters in the brain that becomes disrupted during chronic alcohol use.
• It helps reduce cravings and the discomfort associated with alcohol withdrawal by modulating glutamate and GABA systems.
• The medication is most effective when started as soon as possible after alcohol detoxification and should be continued even if relapse occurs.
• Common side effects include diarrhea, nausea, anxiety, and weakness.
• Acamprosate does not cause adverse reactions if alcohol is consumed while taking it, unlike disulfiram.
• For optimal results, acamprosate should be used as part of a comprehensive treatment program that includes counseling, support groups, and behavioral therapy, as evidenced by the increased effectiveness of combined interventions such as acamprosate and nurse visits, or acamprosate and naltrexone 1.
• The medication typically takes 5-8 days to reach steady-state levels in the body, and treatment usually continues for at least 6-12 months.
• It is essential to note that while acamprosate is effective, the confidence in the evidence for most interventions, apart from acamprosate, is low or very low due to within-study bias, imprecision, and heterogeneity 1.

From the FDA Drug Label

• Acamprosate calcium delayed-release tablets are indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation (1,14). • Treatment with acamprosate calcium delayed-release tablets should be part of a comprehensive management program that includes psychosocial support (1). Acamprosate (Campral®) is used to treat alcoholism by maintaining abstinence from alcohol in patients with alcohol dependence who are already abstinent at the start of treatment 2.

• It is intended as part of a comprehensive management program that includes psychosocial support.

From the Research

Efficacy of Acamprosate in Treating Alcoholism

• Acamprosate (Campral) has been shown to be effective in maintaining abstinence in patients with alcohol dependence, with studies demonstrating its efficacy in improving various key outcomes, including the proportion of patients who maintained complete abstinence from alcohol 3, 4, 5.
• The drug has been found to be generally well tolerated, with a low propensity for drug interactions, and may be used without dosage adjustment in patients with mild to moderate hepatic impairment 4, 6.
• Acamprosate has been compared to other FDA-approved treatments for alcohol dependence, such as naltrexone and disulfiram, and has been found to have similar efficacy to naltrexone, with the combination of acamprosate and naltrexone appearing to be more efficacious than acamprosate alone 5, 7.

Mechanism of Action

• The exact mechanism of action of acamprosate is still under investigation, but it is thought to work by promoting a balance between the excitatory and inhibitory neurotransmitters, glutamate and gamma-aminobutyric acid, respectively 6.
• Acamprosate may help individuals with alcohol dependence by reducing withdrawal-associated distress and altering the conformation of the N-methyl-d-aspartate receptors 6, 7.

Clinical Utility

• Acamprosate has been found to be effective in reducing the risk of returning to any drinking and increasing the cumulative duration of abstinence, although it appears to be no more efficacious than placebo in reducing heavy drinking days 6.
• 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 5, 6.