Pharm

Acamprosate

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Acamprosate, Campral

  • Indications
  1. Maintenance of Alcohol abstinence
  • Contraindications
  1. Severe Renal Insufficiency (CrCl <30 ml/min)
  2. Advanced Cirrhosis (although appears safe in most with impaired hepatic function)
  • Mechanism
  1. Balances GABA and glutamate Neurotransmitters
    1. Blocks Glutaminergic N-methyl-D-Aspartate receptors
    2. Activates GABA Type A receptors
  2. Reduces anxiety from abstinence
  • Dosing
  1. Campral 666 mg (two 333 mg tabs) orally three times daily
    1. Start with one tablet three times daily
    2. Increase with one additional tablet daily each week
    3. Slow titration reduces gastrointestinal side effects
  2. Indications to decrease to 333-666 mg AM, 333 noon, 333 PM
    1. Weight <60 kg
    2. Renal Insufficiency
      1. Creatinine Clearance <50 ml/min, but >30 ml/min
      2. Contraindicated if Creatinine Clearance <30 ml/min
  • Safety
  1. Pregnancy Category C
  2. Lactation: Unknown
  • Adverse Effects
  1. Transient Diarrhea (10%)
  2. Flatulence
  3. Nausea
  4. Insomnia
  5. Depressed mood
  6. Pruritus
  7. Paresthesias
  8. Diaphoresis
  • Efficacy
  1. Reduces short and longterm relapse rates
  2. Sustains Alcohol abstinence (NNT 12) and reduces Problem Drinking (NNT 9)
  3. Yahn (2013) Subst Abuse 6:1-12 [PubMed]
  4. Rosner (2010) Cochrane Database Syst Rev (9): CD004332 [PubMed]
  • Drug Interactions
  1. May be used in combination with Naltrexone
  2. No interaction with Alcohol or Benzodiazepines
  3. No interaction with Disulfiram (Antabuse)
  • Resources
  1. Acamprosate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=43e9ef60-2d85-4394-906b-93042fea099a
  • References
  1. Mason (2001) J Clin Psychiatry 62:42-8 [PubMed]
  2. Winslow (2016) Am Fam Physician 93(6): 457-65 [PubMed]