acamprosate

Acamprosate is a prescription medication used to support abstinence in adults with alcohol use disorder after withdrawal. It is typically prescribed as part of a comprehensive treatment plan that includes psychosocial support and counseling. The drug is marketed under brand names such as Campral and is available as an oral calcium salt of a structural analogue of GABA.

Mechanism of action

Acamprosate is thought to modulate glutamatergic neurotransmission and to stabilize brain activity during early abstinence. By influencing the balance of excitatory and inhibitory signals in the brain, it may reduce cravings and withdrawal-related symptoms that can lead to relapse. The exact mechanism is not fully understood.

Administration and dosing

The usual adult dose is 666 mg taken three times daily (three 333 mg tablets), with meals. Dose can be adjusted in individuals with renal impairment, and it is contraindicated in severe renal impairment or in patients on dialysis. The duration of treatment varies, typically continuing for several months as part of a broader rehabilitation plan.

Pharmacokinetics and interactions

Acamprosate is not extensively metabolized by the liver and is primarily excreted unchanged by the kidneys. It has few clinically significant drug interactions, and alcohol use does not meaningfully alter its pharmacokinetics. Caution is advised in patients with kidney disease.

Adverse effects and safety

Common adverse effects include diarrhea, nausea, flatulence, and, less commonly, vomiting or skin reactions. Serious side effects are rare. Safety in pregnancy and lactation has not been established; benefits and risks should be weighed in such cases.

Efficacy

Clinical trials and reviews show that acamprosate can modestly improve rates of abstinence when combined with psychosocial therapies, but it is not a cure and may be more effective for some individuals than others. It is intended as part of a comprehensive treatment strategy.