Acamprosate For Alcohol Treatment – How Does It Work?

This article will explore acamprosate for 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 this medication one ofe the newest of the three FDA-approved medications for addiction (the others are disulfiram and naltrexone). It is sold under the brand name Campral Delayed Release Tablets.

Many people receiving this care report a reduction in post-acute withdrawal symptoms, including:

• Restlessness
• Insomnia
• Anxiety
• Cravings

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

What is Acamprosate?

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

Is Acamprosate Approved for Treating Alcoholism?

This 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 withdrawal.

In Europe, it 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 – or disulfiram, which causes nausea when drinking – this medication relieves the intense sensation of stress that leads many alcoholics back to the bottle.

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

How Does Acamprosate Work?

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

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

It 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). Withdrawal involves the opposite effect, which is also two-pronged: a lack of GABA and a surge of glutamate.

In the absence of drinking to calm down the brain, the alcoholic feels hyperactive, hypersensitive, and panicked. Many of the symptoms of 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. This medication is thought to be more useful for the long-term management of symptoms when this brain imbalance persists.

Dosage

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

• A typical dose for 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 the remedy is usually between three months and one year. (source)
• Only a doctor can determine your correct dosage depending on your situation.
• It may have interactions with other drugs, but there is no current data on these interactions.
• It does not cause an unpleasant reaction when consumed with alcohol.
• It is often taken on its own or in conjunction with benzodiazepines for withdrawal.
• Because everyone is biochemically different, some people do not respond well (or at all).
• Because It is not processed by the liver, it may be suitable for people with liver disease. However, because it is excreted by the kidneys, it should be avoided by people with severe kidney problems.

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

• Overview
• Side effects

Research Studies

A number of studies support the use of acamprosate:

• Of 272 alcoholic patients, half of whom received acamprosate for 48 weeks and half of whom received a placebo, the former group experienced a significantly higher abstinence rate. Higher abstinence for the former group continued during the following 48 weeks, during which no medications were given to either group. (source)
• This medication 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 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 the medication 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 the medication and 23.4% of individuals receiving placebo remained abstinent at 6 months. (source)
• A study comparing this medication versus naltrexone for dependence concluded that this medication improves abstinence odds, with 77% of the acamprosate remaining abstinent 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 studies found that this medication increases abstinence rates, reduces treatment costs, and produces superior results compared to group support alone. (source)

In addition to the above research, 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).

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.

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

• Naltrexone
• Gabapentin
• Topamax

Further Considerations – Nutritional Repair

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

Nutrition is one of the most neglected pillars of 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 recovery.

Conclusion

People with substance abuse disorders deserve to know about all of their options for changing their lives for the better.

There is no one-size-fits-all approach to 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 for 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.