Acamprosate Alcohol Treatment – How Does Acamprosate Work?

acamprosate alcohol treatment

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.

acamprosate alcohol treatment campral

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.

Overview of Acamprosate

acamprosate alcohol treatment

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.

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.

acamprosate alcohol treatment

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

acamprosate alcohol treatment

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:

Research Studies

acamprosate alcohol treatment

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:

Further Considerations – Nutritional Repair

acamprosate alcohol treatment

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.

___________________________________

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.

Hierarchy of Alcohol Recovery

Please review this post!

WANT TO DOMINATE ALCOHOL AND LIVE YOUR BEST LIFE?

CHRIS SCOTT

Chris Scott founded Fit Recovery in 2014 to help people from around the world dominate alcohol dependence and rebuild their lives from scratch. A former investment banker, he recovered from alcohol dependence using cutting-edge methods that integrate nutrition, physiology, and behavioral change. Today, Chris is an Alcohol Recovery Coach and the creator of an online course called Total Alcohol Recovery 2.0.

DR. REBECA ERIKSEN

Dr. Rebeca Eriksen is the Nutritional Consultant for Fit Recovery. She has a PhD in Nutritional Genetics from Imperial College London, and over ten years of clinical experience designing custom nutritional repair regimens for patients recovering from alcohol addiction. In addition to her work at the exclusive Executive Health clinic in Marbella, Spain, she helps to keep Fit Recovery up to date with emerging research.

COMMENT DISCLAIMER

The information we provide while responding to comments is not intended to provide and does not constitute medical, legal, or other professional advice. The responses to comments on fitrecovery.com are designed to support, not replace, medical or psychiatric treatment. Please seek professional care if you believe you may have a condition.

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AD
AD
3 years ago

Hi Chris. Lot’s of great info here. Just a quick question. I tend not to drink for a month or so then drink heavily morning til night for about 10-14 days. I’m fine for the first few days, but after that I’m drinking just to avoid the hangover which is 95% mental (brain fog, boredom, anxiety). I don’t get any cravings whatsoever during the sober periods, but once i start the bar is like a strong magnet pulling me in as soon as i wake and it usually takes me a few days to be able to sleep after I… Read more »

Chris Scott
3 years ago
Reply to  AD

Hi AD, great question and I can relate to your situation. If you were to be prescribed Campral, a doctor would have to determine the correct dosage because many factors are involved (bodyweight, tolerance, etc.). The cycle that you are describing occurred to me when I was younger, and I wish someone had told me that eventually the sober periods would imperceptibly shrink to a few weeks, then a week, then a few days, then a few hours. So I think it’s smart that you want to nip this cycle in the bud. If I were you, I would begin… Read more »

Gaby Lau
Gaby Lau
3 years ago

Very good article. I have a Masters in Psychology and have suffered for many years with alcohol abuse. I finally went into a day rehab centre and was told there by many patients that Acamprosate had worked on them, so just started taking it myself. It’s unbelievable that there is so little information out there on it and like you, none of the numerous doctors I saw about my alcohol problem told me this even existed or was an option. There should be more awareness of it and how it differs drastically from Naltrexone and Antabuse (Disulfiram).

Chris Scott
3 years ago
Reply to  Gaby Lau

Thanks Gaby, it’s very frustrating that the treatment options for alcoholism are rarely presented in their entirety.

I’m glad you enjoyed the article and nice work on being proactive yourself! Best of luck to you, and stay posted for more.

john duffy
4 years ago

Excellent info. I will read it a few times.
I am 62 and I began drinking at 16. My problem is more ‘binge’, 2-3 times a month. I’m ok if I stay away but, in a bar, if I drink 6 beers, I must have 6 more. Would Campral help here? I’m seeing a counsellor but I cannot develop adequate self-discipline. Thank you.
John Duffy
Ireland

Chris Scott
4 years ago
Reply to  john duffy

Thanks John – Campral may help if you suffer from anxiety or depression that causes you to binge drink. However, it is usually prescribed for people who have had a hard time withdrawing from alcohol. It sounds like your binge drinking might be helped by The Sinclair Method, which involves taking naltrexone prior to drinking. Over time, naltrexone helps to extinguish the desire to drink excessively. A growing number of doctors are open to prescribing naltrexone for alcohol problems – although it can still be hard to find one, depending on where you live. I can assure you that you’ll… Read more »

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