Class
- Alcohol Abstinence Aid
Indications
- Maintenance of abstinence in alcohol-dependent individuals who are undergoing counseling or therapy.
- Reduces the risk of relapse in patients who have achieved abstinence.
Mechanism of Action
- Modulates the activity of neurotransmitters in the brain, particularly glutamate and GABA.
- Reduces post-acute withdrawal symptoms and cravings for alcohol.
Dosage and Administration
Typical Dosage for Adults
- Recommended Dose: 666 mg (two 333 mg tablets) three times daily.
- Adjusted Dose for Renal Impairment: 333 mg three times daily for moderate renal impairment (creatinine clearance 30–50 mL/min).
- Not Recommended: In patients with severe renal impairment (creatinine clearance <30 mL/min).
Administration
- Take tablets with or without food.
- Swallow tablets whole; do not crush or chew.
- Should be started after alcohol withdrawal and once abstinence is achieved.
Forms Available
- Tablets: 333 mg
Brand Names and Manufacturers
- Campral (Forest Pharmaceuticals, a subsidiary of Allergan).
- Generic acamprosate tablets are also available.
Cost
- Generic acamprosate is more affordable, with costs ranging from $50–$150 per month, depending on the pharmacy and insurance coverage.
Contraindications
- Hypersensitivity to acamprosate or any component of the formulation.
- Severe renal impairment (creatinine clearance <30 mL/min).
Precautions
- Should not be used as a standalone treatment; works best alongside counseling or behavioral therapy.
- Does not prevent withdrawal symptoms and is not suitable for detoxification.
- Use with caution in patients with moderate renal impairment.
Side Effects
Common
- Diarrhea
- Nausea
- Abdominal pain
- Fatigue
Less Common
- Dizziness
- Dry mouth
- Itching or skin rash
Rare but Serious
- Severe allergic reactions (e.g., swelling, difficulty breathing).
- Suicidal thoughts or behavior (monitor mood changes).
Drug Interactions
- No significant drug interactions noted with commonly used medications.
- Safe to use with other medications for alcohol dependence, such as disulfiram or naltrexone.
- Does not interact with alcohol; ineffective if alcohol is consumed.
Monitoring Parameters
- Assess adherence to the medication regimen and abstinence status.
- Monitor renal function periodically, especially in patients with pre-existing renal impairment.
- Evaluate for signs of mood changes or suicidal thoughts.
Patient Counseling Points
- Acamprosate is most effective when combined with counseling or a structured treatment program.
- Continue taking even if cravings subside; stopping abruptly may increase the risk of relapse.
- Inform your doctor about any significant mood changes or suicidal thoughts.
- Avoid consuming alcohol while on acamprosate to maximize its effectiveness.
- Take doses at regular intervals to maintain consistent blood levels.
- It may take a few weeks to see the full benefit; patience is key.
FAQs About Acamprosate
Q1: How does acamprosate help with alcohol dependence?
- It stabilizes brain chemistry disrupted by chronic alcohol use, reducing cravings and post-acute withdrawal symptoms.
Q2: Can acamprosate be used during alcohol detoxification?
- No, it is not effective for managing withdrawal symptoms and should be started after achieving abstinence.
Q3: How long should acamprosate be taken?
- Typically prescribed for 6–12 months, but longer durations may be recommended based on individual needs.
Q4: Does acamprosate interact with alcohol?
- No, it does not interact with alcohol but is ineffective if alcohol is consumed during treatment.
Q5: Can acamprosate cause weight gain?
- Weight gain is not a common side effect of acamprosate.
Q6: Can pregnant women take acamprosate?
- Safety in pregnancy has not been established; use only if clearly needed and prescribed by a doctor.
Q7: Is acamprosate addictive?
- No, it has no potential for abuse or dependence.
Q8: What should I do if I miss a dose?
- Take it as soon as you remember unless it’s close to the next scheduled dose; do not double doses.
Q9: Can acamprosate be taken with antidepressants?
- Yes, it can be safely taken with most antidepressants, but inform your doctor about all current medications.
Q10: How soon does acamprosate start working?
- It may take a few weeks of consistent use to notice reduced cravings or improved abstinence.
Q11: Can acamprosate prevent relapse on its own?
- No, it must be combined with behavioral therapy or counseling for optimal results.
Q12: Can I drive while taking acamprosate?
- Acamprosate does not typically cause drowsiness, but avoid driving if you feel dizzy or fatigued.
Q13: Is acamprosate effective for all individuals with alcohol dependence?
- Effectiveness varies; it works best for individuals committed to abstinence and therapy.
Q14: Does acamprosate affect the liver?
- No, acamprosate is primarily excreted by the kidneys and has minimal impact on liver function.
Q15: How does acamprosate compare to naltrexone?
- Acamprosate reduces cravings and withdrawal symptoms, while naltrexone blocks the pleasurable effects of alcohol.