How Does Acamprosate Work for Treating Alcoholism?

This article will explore acamprosate alcohol treatment. Acamprosate is a prescription medication that is used to help people manage post-acute alcohol withdrawal syndrome (PAWS).

The FDA approved acamprosate for alcohol dependence in 2004. This makes acamprosate the newest of the three FDA-approved medications for alcoholism (the others are disulfiram and naltrexone). Acamprosate is sold under the brand name Campral Delayed Release Tablets.

Many people receiving acamprosate alcohol treatment report a reduction in post-acute withdrawal symptoms, including:

• Restlessness
• Insomnia
• Anxiety
• Alcohol cravings

We will now proceed to explore acamprosate alcohol treatment, including pharmacology, dosage information, research studies, and alternatives to this medication.

What is Acamprosate?

Acamprosate may help to ameliorate post-acute withdrawal syndrome, with a notable impact for some people on anxiety and alcohol cravings. It does this by stabilizing brain chemicals involved in alcohol withdrawal.

Is Acamprosate Approved for Treating Alcoholism?

Acamprosate for alcohol dependence is typically prescribed for 3-12 months following the cessation of acute withdrawal symptoms. This sets it apart from anticonvulsants (e.g., benzodiazepines) that are prescribed to prevent complications during acute alcohol withdrawal.

In Europe, acamprosate for alcohol dependence had been used with apparent success for decades before it was approved in the U.S.

In contrast to naltrexone, which blocks the pleasure that drinkers obtain from alcohol – or disulfiram, which causes nausea when alcohol is consumed – acamprosate relieves the intense sensation of stress that leads many alcoholics back to the bottle.

There is evidence that acamprosate works best for people who are committed to abstinence from alcohol. However, people who “slip” while taking acamprosate for alcohol dependence are usually advised to continue taking the drug.

How Does Acamprosate Work?

While scientists still do not fully understand how acamprosate alcohol treatment works, it is thought that acamprosate reduces glutamate activity in the brain.

Glutamate is a “stress” chemical that is suppressed by chronic alcohol use, and which rebounds to potentially dangerous levels when alcoholics attempt to quit cold turkey.

Acamprosate may also modulate GABA activity, possibly indirectly through its action as a glutamate antagonist. GABA is the brain’s primary “calming” chemical.

In order to understand why this matters, it’s important to remember that alcohol mimics GABA (calming the brain) and suppresses glutamate (reducing stress). Alcohol withdrawal involves the opposite effect, which is also two-pronged: a lack of GABA and a surge of glutamate.

In the absence of alcohol to calm down the brain, the alcoholic feels hyperactive, hypersensitive, and panicked. Many of the symptoms of alcohol withdrawal are caused by a lack of GABA and an excess of glutamate.

In the short term, benzodiazepines that stimulate GABA receptors are often used to resolve this chemical imbalance. However, benzodiazepines can lead to rapid tolerance and addiction. Acamprosate is thought to be more useful for long-term management of symptoms when this brain imbalance persists.

Acamprosate Dosage

The following dosage information may be useful if you are considering acamprosate alcohol treatment:

• A typical dose of acamprosate for alcohol dependence is 666 mg, three times per day.
• The brand name Campral comes in tablets of 333 mg, meaning that two tabs are often taken at once.
• The duration of acamprosate alcohol treatment is usually between three months and one year. (source)
• Only a doctor can determine your correct dosage depending on your situation.
• Acamprosate may have interactions with other drugs, but there is no current data on these interactions.
• Acamprosate does not cause an unpleasant reaction when consumed with alcohol.
• Acamprosate for alcohol dependence is often taken on its own or in conjunction with benzodiazepines for alcohol withdrawal.
• Because everyone is biochemically different, some people do not respond well (or at all) to acamprosate alcohol treatment.
• Because acamprosate is not processed by the liver, it may be suitable for people with liver disease. However, because acamprosate is excreted by the kidneys, it should be avoided by people with severe kidney problems.

Before taking acamprosate for alcohol dependence, make sure to review the following:

• Overview
• Side effects

Research Studies

A number of studies support the use of acamprosate for alcohol dependence:

• Of 272 alcoholic patients, half of whom received acamprosate for 48 weeks and half of whom received placebo, the acamprosate alcohol treatment group experienced a significantly higher abstinence rate. Higher abstinence for the acamprosate group continued during the following 48 weeks, during which no medications were given to either group. (source)
• Acamprosate was shown to be well tolerated and very effective at increasing abstinence rates for alcoholic patients in a double blind study, in which two dosages of acamprosate alcohol treatment were used: 1,332 mg/day and 1,998 mg/day. Higher abstinence rates were noted with increased dosage. (source)
• In a study of alcoholics in real-world conditions, 540 individuals who received acamprosate alcohol treatment were found to have a 33.6% abstinence rate compared to 21.6% for 274 individuals who received only psychosocial support. (source)
• A comprehensive meta-study of 17 trials consisting of 4,087 patients from 13 countries found that 36% of individuals receiving acamprosate alcohol treatment and 23.4% of individuals receiving placebo remained abstinence at 6 months. (source)
• A study comparing acamprosate versus naltrexone for alcohol dependence concluded that acamprosate alcohol treatment improves abstinence odds, with 77% of the acamprosate remaining abstinence versus 36% for naltrexone and 50% for placebo. (It should be noted that abstinence is not always the primary goal with naltrexone treatment.) (source)
• A critical review of acamprosate alcohol treatment studies found that acamprosate increases abstinence rates, reduces treatment costs, and produces superior results compared to group support alone. (source)

In addition to the above research on acamprosate alcohol treatment, the following passage from the scientific literature is worth considering:

Discrepancies [in acamprosate’s effectiveness] may be mediated by genetic differences in the populations examined. For example, exciting emerging evidence suggests that alcohol effects are altered in mice carrying various mutations of the glutamatergic genes (see review by Gass and Olive 2008). If the effects of acamprosate are indeed mediated through this glutamatergic system, it would be worth examining these genetic markers as mediators of treatment response. Finally, patient-specific treatment matching also may enhance acamprosate’s efficacy. Evidence from a pooled analyses of seven European trials suggests that alcoholics with increased levels of anxiety, negative family history, and late age of onset of alcoholism, as well as those who are women, may benefit from this medication (Verheul et al. 2005). (emphasis added; source)

Acamprosate Alternatives

Not everyone can obtain acamprosate, since it must be prescribed by a doctor.

Besides benzodiazepines, which are the most commonly prescribed drugs for short-term alcohol detox, there are a few other alternatives to acamprosate alcohol treatment.

You can read some other articles on prescription medications for alcohol withdrawal and alcohol cravings here:

• Naltrexone
• Baclofen
• Gabapentin
• Topamax

Further Considerations – Nutritional Repair

After getting through acute alcohol withdrawal, it’s important to determine what lifestyle changes will reduce alcohol cravings and repair the body-brain system.

Nutrition is one of the most neglected pillars of alcohol recovery. After removing toxic ethanol from your life, you can maximize your sense of well-being by optimizing what you put into your body. This includes eating well and taking supplements to repair nutritional deficiencies.

Check Fit Recovery’s list of supplements that work best for supporting the brain-body system through alcohol recovery.

Conclusion

People with alcohol disorders deserve to know about all of their options for changing their lives for the better, including acamprosate for alcohol dependence.

There is no one-size-fits-all approach for alcohol detox and recovery. Most people who quit are not informed about nutrient repair, pharmacological support, or holistic strategies for improving their quality of life.

If you have any questions about acamprosate alcohol treatment, please leave them in the comment box below.

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Dr. Ken Starr is board certified in both Addiction Medicine and Emergency Medicine, and diplomate of the American Board of Addiction Medicine. In addition to his work as the Addiction Medicine Director for Fit Recovery, he operates Ken Starr MD Wellness Group in Arroyo Grande, CA. His clinic offers advanced drug and alcohol detox methods, long term recovery facilitation, and IV nutritional programs including NAD+ therapy.