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Alcohol use disorder (AUD) is a chronic medical condition characterized by a problematic pattern of alcohol use, including an inability to control drinking despite causing negative consequences, leading to significant impairment in overall health, socialization, and occupational functioning.[1]
However, treating AUD—that is, maintaining abstinence—is challenging due to high relapse rates and the complexity of implementing comprehensive approaches. It is vital to combine medication and behavioral therapies, which requires tailored care, coordination between providers, consistent patient engagement, and cost considerations.
Acamprosate (commonly sold under the name Campra) is a pharmacological treatment that has shown promise in supporting abstinence, particularly when used alongside psychosocial interventions.[2]
- Acamprosate is a medication used to help individuals with alcohol use disorder (AUD) maintain abstinence by stabilizing brain chemicals that are disrupted by prolonged alcohol use.
- Acamprosate reduces cravings, improves abstinence rates, and is effective when combined with psychosocial therapies. It is safe for individuals with liver dysfunction and can be combined with other medications (like naltrexone) for enhanced results.
- Common side effects include diarrhea, headaches, fatigue, and insomnia. Rare but serious risks include allergic reactions, kidney impairment, and suicidal ideation. It is contraindicated for those with severe renal impairment, hypersensitivity, or during pregnancy and breastfeeding.
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What is acamprosate?
Acamprosate is a safe and well-tolerated AUD medication that has been studied in clinical trials worldwide. It is used primarily to support people recovering from alcohol dependence.[3]
Acamprosate can be initiated if the person is still actively using alcohol, but the efficacy of treatment during active alcohol use is unknown.[2] Doctors should begin therapy with acamprosate as soon as the person has abstained from alcohol use (within 7 days) for the best treatment response.[2]
Acamprosate helps maintain abstinence by restoring the chemical balance in the brain, which may be disrupted by chronic alcohol use. Specifically, it is believed to modulate activity in the glutamate (excitatory) and GABA (inhibitory) neurotransmitter systems, reducing the symptoms of prolonged withdrawal and cravings for alcohol. [3]
Acamprosate, in combination with psychosocial support, was approved by the Food and Drug Administration (FDA) in July 2004 for the maintenance of abstinence from alcohol after undergoing detox. [4]
How acamprosate works for alcohol use disorder
Acamprosate is an AUD medication that helps people stay sober after they’ve stopped drinking. It works by restoring balance in the brain's chemical signals, specifically by calming the overactive glutamate system and stabilizing the calming GABA system.[5]
It acts on the same glutamatergic N-methyl-D-aspartate (NMDA) receptors that are affected by chronic alcohol use. When used in alcohol-dependent patients, acamprosate is associated with a reduction of alcohol cravings and increased rates of abstinence from alcohol use.
It’s beneficial for helping people avoid relapse that can be triggered by stress or situations linked to their previous drinking habits. [6]
How effective is it?
| Medication | Mechanism of action | Best suited for | Effectiveness | Key considerations |
|---|---|---|---|---|
| Acamprosate | Stabilizes brain chemistry by modulating GABA and glutamate neurotransmitter systems | Patients committed to abstinence and post-detoxification | Increases abstinence rates by 14% | Safe for patients with liver dysfunction; requires psychosocial support for optimal results |
| Naltrexone | Blocks opioid receptors, reducing alcohol’s pleasurable effects and cravings | Individuals aiming to reduce heavy drinking or maintain sobriety | Reduces heavy drinking episodes | May not be suitable for people with liver disease or at high risk of nausea and fatigue |
| Disulfiram | Causes unpleasant reactions (e.g., nausea, flushing) when alcohol is consumed | Highly motivated individuals who want to avoid drinking entirely | Effective for aversion therapy | Requires strict adherence; not effective for cravings or withdrawal symptoms |
Who is acamprosate suitable for?
Acamprosate is suitable for the following groups of people: [4][5][7]
- People who are alcohol-dependent post detoxification
- People committed to abstinence
- People with protracted withdrawal that need craving reduction
- People with comorbid liver conditions
- People receiving psychosocial support
Acamprosate dosage and usage guidelines for AUD treatment
Always take this medicine exactly as your doctor or pharmacist has told you.
Dosage
- The recommended dose of acamprosate is two 333 mg tablets (each dose should total 666 mg), which are taken three times daily for a total of 6 tablets per day.
- A lower dose may be effective in some patients at dosages of 4 or 6 tablets daily. [10]
Although you can drink the medication without food, taking the drug with food was tested during clinical trials and is recommended.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.
Treatment with acamprosate should be started as soon as possible after the period of alcohol withdrawal, when the patient has achieved abstinence, and should be maintained if the patient relapses. Additionally, acamprosate should be used in conjunction with a psychosocial treatment program.
Precautions before taking acamprosate
Do not take acamprosate if you are allergic to its ingredients, breastfeeding, or have severe kidney disease. It is generally not recommended for those under 18, over 65 (without dosage adjustment), with severe liver disease, or alcohol withdrawal syndrome. [10]
Monitor for symptoms of depression or suicidal thoughts while taking acamprosate, and inform your doctor about any medications you are using especially diuretics. Avoid alcohol as it may reduce the drug’s effectiveness.
Potential side effects and risks of acamprosate
The lists below contain common side effects, rare but potentially serious side effects, contraindications, and warning signs of acamprosate.
Common side effects: [4][12][13]
- Diarrhea
- Nausea
- Abdominal pain
- Excessive gas
- Loss of appetite
- Dry mouth
- Headaches
- Dizziness
- Insomnia
- Fatigue
- Sweating
- Drowsiness
- Rashes
- Pruritus
Rare but serious risks
Rare but serious risks include: [7][14]
- Severe allergic reactions, including several types (hypersensitivity reactions; angioedema, which is sudden swelling under the skin, usually in places like your lips, throat, tongue, eyes, hands, or feet, potentially leading to difficulty breathing)
- Kidney impairment
- Suicidal thoughts and ideations
- Depression
Contraindications and precautions
Acamprosate is generally safe and well-tolerated, but certain conditions and factors warrant caution or contraindicate its use:
- Severe kidney impairment: Acamprosate is contraindicated in individuals with severe renal dysfunction.[5]
- Allergies: Avoid use in patients with known hypersensitivity to acamprosate or its ingredients.[5]
- Pregnancy and breast-feeding: Limited safety data exist, so acamprosate should only be used if the potential benefits outweigh the risks.[12]
- Mental health risks: Individuals with a history of mental health conditions or suicidal thoughts should be monitored closely for increased suicide risk.[4]
- Pediatric use: Not recommended for those under 18 years old due to insufficient safety data.
Healthcare providers should also monitor for gastrointestinal side effects, neuropsychiatric symptoms, and potential kidney problems, especially in patients with pre-existing conditions.
Overdose effects
The signs of an acamprosate overdose usually present as diarrhea, which may be mild to severe.
If you or someone else has used too much acamprosate, get medical help immediately. Call 911 or contact a Poison Control center at 800-222-1222, which offers help around the clock.
Speaking to your provider about acamprosate
- Prepare a list of questions: Ask about acamprosate’s benefits for maintaining abstinence, how it works with other treatments, and potential side effects.
- Be open about your medical history: Provide your full medical history, current medications, and disclose if you're pregnant, breastfeeding, or planning to become pregnant.
- Express your treatment goals: Clarify if your goal is abstinence or reduced alcohol use, and explore combining acamprosate with other medications like naltrexone or disulfiram to enhance effectiveness.
- Ask about monitoring and support: Inquire about follow-up visits, side effect management, and additional resources like counseling, group therapy, or community support for AUD.
Integrating acamprosate into a recovery plan
Integrating acamprosate into a recovery plan for alcohol dependence can be beneficial when it is combined with psychosocial and behavioral therapies. Key findings on acamprosate's effectiveness highlight its ability to improve abstinence rates,[4][6] reduce cravings and enhance recovery,[5] work well in combination therapies,[11] and demonstrate good safety and tolerability.[12]
Recommendations for recovery plans
- Incorporate acamprosate into a structured recovery plan post-detoxification.
- Combine it with psychosocial or behavioral therapies, such as counseling or cognitive-behavioral therapy (CBT), for better outcomes.
- For patients with severe dependence, consider combination pharmacotherapies with naltrexone or disulfiram.
Acamprosate is an effective and safe adjunctive treatment for maintaining abstinence from alcohol dependence, mainly when used in conjunction with psychosocial therapies and supportive care. Its role in managing cravings and withdrawal-related stressors makes it a valuable component of recovery plans.
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