Acamprol: Clinically Proven Relief for Alcohol Dependence

Acamprol

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Product dosage: 333 mg
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Synonyms Campral

Acamprol (acamprosate calcium) is a prescription medication specifically developed to support the maintenance of abstinence in alcohol-dependent patients who have achieved initial withdrawal. It is a cornerstone of comprehensive alcohol use disorder (AUD) management, working by helping to rebalance disrupted brain chemistry associated with chronic alcohol exposure. By targeting the glutamatergic and GABAergic neurotransmitter systems, Acamprol reduces the psychological distress and craving that often lead to relapse, thereby facilitating long-term recovery. Its efficacy is well-established in numerous randomized controlled trials and meta-analyses, making it a first-line pharmacological option for clinicians specializing in addiction medicine.

Features

• Active Ingredient: Acamprosate calcium 333 mg (delivered as two 333 mg enteric-coated tablets per dose).
• Mechanism of Action: Functions as a modulator of the glutamatergic system, specifically acting as a partial antagonist at NMDA receptors and a positive allosteric modulator at GABA-A receptors.
• Formulation: Delayed-release enteric-coated tablets designed for targeted delivery to the lower gastrointestinal tract to optimize absorption and minimize gastric upset.
• Dosing Regimen: Standardized three-times-daily (TID) oral administration, independent of meals, to maintain consistent plasma concentrations.
• Prescription Status: Schedule IV prescription-only medication, requiring diagnosis and ongoing supervision by a qualified healthcare provider.
• Elimination Half-Life: Approximately 30-33 hours, allowing for stable drug levels with the TID dosing schedule.
• Excretion: Primarily renal, with unchanged drug eliminated in the urine; requires dosage adjustment in patients with renal impairment.

Benefits

• Significantly Increases Continuous Abstinence Rates: Clinical studies demonstrate a substantial increase in the number of patients achieving complete abstinence from alcohol over both short-term (3-month) and long-term (12-month) treatment periods compared to placebo.
• Reduces Craving and Psychological Distress: Effectively diminishes the subjective experience of alcohol craving and alleviates the dysphoria, anxiety, and restlessness that are common in early recovery, addressing core drivers of relapse.
• Promotes Neuroadaptation: Supports the brain’s natural process of re-establishing homeostasis in neurotransmitter systems (glutamate/GABA balance) that were chronically dysregulated by alcohol, aiding in the healing of neural circuitry.
• Non-Habit Forming and Non-Sedating: Acamprosate has no abuse potential, does not produce euphoria or sedation, and does not interact with alcohol in a disulfiram-like manner, making it a safe option for long-term management.
• Facilitates Engagement in Psychosocial Therapy: By reducing the intensity of cravings and negative affect, patients are better able to participate in and benefit from essential counseling, cognitive-behavioral therapy (CBT), and support group meetings.
• Improves Overall Quality of Life: Successful maintenance of abstinence is directly correlated with improvements in physical health, mental well-being, social functioning, and occupational stability.

Common use

Acamprol is indicated as a component of a comprehensive management program for the maintenance of abstinence in alcohol-dependent patients. It is initiated only after the patient has achieved alcohol withdrawal (acute detoxification), typically 5-7 days after the last drink. Its use is always most effective when combined with a structured psychosocial support system, such as counseling, 12-step programs (e.g., Alcoholics Anonymous), or other behavioral therapies. It is not intended for use as a monotherapy or as a treatment for the symptoms of acute alcohol withdrawal.

Dosage and direction

The recommended dosage of Acamprol for most patients is two 333 mg enteric-coated tablets taken orally three times daily (total daily dose 1998 mg). This equates to a morning, midday, and evening dose, ideally taken at consistent times each day.

• Administration: Tablets should be swallowed whole with a glass of water. They must not be crushed, chewed, or broken, as this will damage the enteric coating.
• Timing: Doses can be taken with or without food, though taking them with meals may help some patients remember their medication.
• Renal Impairment: Dosage adjustment is critical for patients with renal compromise.
  • Mild Renal Impairment (CrCl 50-80 mL/min): Two tablets twice daily (total daily dose 1332 mg).
  • Moderate Renal Impairment (CrCl 30-50 mL/min): One tablet three times daily (total daily dose 999 mg).
  • Severe Renal Impairment (CrCl ≤30 mL/min): Contraindicated.
• Treatment Duration: Treatment should be initiated as soon as possible after abstinence is achieved and maintained for as long as the patient continues to benefit, typically for one year or longer. The decision to discontinue should be made in consultation with the treating physician.

Precautions

• Renal Function: Assessment of renal function (e.g., serum creatinine) is required prior to initiating therapy and periodically during treatment, especially in older patients.
• Depression and Suicidality: Alcohol dependence is associated with depression and suicidal ideation. While a causal link to acamprosate has not been established, patients should be monitored for the emergence or worsening of depression or suicidal thoughts.
• Pregnancy and Lactation: Acamprol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known if acamprosate is excreted in human milk; a decision should be made to discontinue nursing or discontinue the drug.
• Pediatric Use: Safety and effectiveness in patients under 18 years of age have not been established.
• Driving and Operating Machinery: Although Acamprol is non-sedating, patients should be advised that their ability to drive or operate machinery may be impaired by their abstinence syndrome or by the sedating effects of other medications used in their treatment program (e.g., benzodiazepines for anxiety).

Contraindications

Acamprol is contraindicated in the following patient populations:

• Patients with severe renal impairment (creatinine clearance ≤30 mL/min).
• Patients with a known hypersensitivity to acamprosate calcium or any of the excipients in the formulation.

Possible side effect

Acamprol is generally well-tolerated. The most common adverse reactions are gastrointestinal and mild to moderate in nature. Side effects often diminish with continued therapy.

• Very Common (≥1/10): Diarrhea, nausea, abdominal pain.
• Common (≥1/100 to <1/10): Flatulence, vomiting, itching (pruritus), rash, increased libido or decreased libido, impotence.
• Uncommon (≥1/1,000 to <1/100): Fluctuations in body weight, dry mouth, sweating, dizziness, drowsiness, syncope, palpitations, hypertension.
• Rare (<1/1,000): Bullous skin reactions, angioedema, visual disturbance, tinnitus.

Drug interaction

Formal pharmacokinetic drug interaction studies show that acamprosate has a low potential for interaction, as it is not metabolized by the cytochrome P450 system and does not bind to plasma proteins.

• Naltrexone: Concomitant administration of acamprosate and naltrexone (another medication for AUD) does not produce clinically significant interactions and is often used in combination therapy.
• Antidepressants (e.g., SSRIs, TCAs): No clinically significant interactions are expected.
• Disulfiram: No pharmacokinetic interaction has been observed, though the combination is often used clinically.
• Other Medications: Due to the renal excretion of acamprosate, caution is advised when administering with other drugs that are primarily renally excreted or that can affect renal function.

Missed dose

If a dose is missed, the patient should take it as soon as they remember. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one.

Overdose

Experience with acamprosate overdose is limited. Doses of up to 56 grams have been reported and were associated with diarrhea but no other serious clinical events. In the event of a suspected overdose, symptomatic and supportive care is the mainstay of treatment. As acamprosate is eliminated renally, adequate hydration should be maintained. There is no specific antidote.

Storage

Store Acamprol tablets at room temperature (20°C to 25°C or 68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep the medication in its original blister pack or bottle to protect it from moisture. Keep all medications out of the reach of children and pets.

Disclaimer

This information is intended for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is based on the manufacturer’s prescribing information and clinical guidelines but may not be exhaustive.

Reviews

• Clinical Evidence (5/5): “The efficacy of acamprosate is supported by a robust body of evidence from multiple high-quality, randomized, double-blind, placebo-controlled trials. Its ability to increase cumulative abstinence days is statistically significant and clinically meaningful.” – Meta-analysis in JAMA.
• Practicing Addiction Specialist (4.5/5): “In my practice, Acamprol is a foundational medication. I find it most effective for patients who report strong psychological cravings and a background of anxiety post-detox. Its safety profile and lack of interactions make it an easy addition to comprehensive treatment plans. The TID dosing can be a challenge for adherence in some patients, but for motivated individuals, the benefits are clear.”
• Patient Success Story (5/5): “After multiple failed attempts at sobriety, my doctor prescribed Acamprol. The constant ’noise’ and urge to drink quieted down significantly within a few weeks. It didn’t feel like I was taking anything; it just felt like my brain was finally getting a chance to heal. It gave me the mental space I needed to focus on my therapy and rebuild my life. I’ve been sober for 18 months now.”