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Does acamprosate help with alcohol withdrawal?

Acamprosate is a synthetic amino acid and a neurotransmitter analogue that is used as an alcohol deterrent in management of alcohol dependence and abuse. While it does not prevent acute alcohol withdrawal symptoms, acamprosate can help regulate brain chemicals. It has been shown to address (and lower) cravings for alcohol. Plus, acamprosate can help reduce symptoms of post acute (protracted) withdrawal, such as insomnia, anxiety, and restlessness.

So, can acamprosate help with alcohol withdrawal? How is it prescribed and is it safe for everyone? Find out more about the effectiveness of acamprosate in the text that follows. Then, we invite your questions about using acamprosate in the treatment of alcoholism. Please leave your questions in the comments section at the end. We try to respond to all questions with a personal and prompt reply.

What is alcohol withdrawal?

Alcohol withdrawal refers to symptoms that occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol. Alcohol withdrawal occurs when the body has become physically DEPENDENT on alcohol for normal function. Withdrawal most often occurs in adults, but it may occur in teenagers or children. More severe withdrawal symptoms occur if you have certain other medical problems, drinking heavily, or have been drinking chronically for a period longer than a year or two.

Alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can occur days later. Symptoms usually peak by 24 – 72 hours, but may persist for weeks. So, how can withdrawal be treated? Does acamprosate help?

How can acamprosate help with alcohol withdrawal?

Acamprosate does not prevent the withdrawal symptoms that people may experience when they stop drinking alcohol. In fact, acamprosate has not been shown to work in people who have not stopped drinking alcohol or in people who drink large amounts of alcohol and also overuse or abuse other substances such as street drugs or prescription medications. In order for acamprosate to help, you need to first end physical dependence on alcohol. So what does acamprosate DO, exactly? And how can it help you avoid drinking in the future?

Acamprosate has been shown to be an effective treatment for relapse prevention in alcohol dependent patients. The mechanism of acamprosate action is unknown, but experts think that it modulates craving responses in the brain, particularly in the glutamate and gamma-aminobutyric acid (GABA) neurotransmitter systems. It can take 5 to 8 days before acamprosate is fully effective, during which time acamprosate is used along with counseling and social support to help people avoid drinking alcohol again.

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To keep it simple, drinking alcohol for a long time changes the way the brain works. Acamprosate works by helping the brains of people who have drunk large amounts of alcohol to work normally again. This way, people in recovery can focus on the deeper psychological issues compelling drinking, with lessened symptoms of post-acute withdrawal (PAWS), such as insomnia, anxiety, and restlessness.

Acamprosate prescription for alcohol withdrawal treatment

Acamprosate comes as a delayed-release (releases the medication in the intestine) tablet to take by mouth. It is usually taken with or without food three times a day. To help you remember to take acamprosate, take it around the same times every day. Taking acamprosate with breakfast, lunch, and dinner may help you to remember all three doses. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

Take acamprosate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the tablets whole; do not split, chew, or crush them.

Acamprosate can help alcohol withdrawal (or it may not)

Research on the effectiveness of acamprosate in treating the symptoms of acute withdrawal has been inconclusive. In fact, the FDA has not approved the use of acamprosate for alcohol dependence. Instead, acamprosate has been approved by the FDA for post withdrawal maintenance of alcohol abstinence. However, patients who are already taking acamprosate and who relapse may be medically withdrawn from alcohol without discontinuing acamprosate.

While we do not yet know HOW acamprosate works, it seems to alleviate symptoms of post acute withdrawal (PAWS). Optimal and effective use of acamprosate occurs when patients are abstinent at treatment initiation, start taking acamprosate immediately following acute withdrawal, and are committed to recovery. Because acamprosate does not interact with benzodiazepines or other medications used in medical detoxification, it can be continued safely if a person returns to drinking and subsequently requires detoxification.

Because acamprosate is not metabolized by the liver, it can be used safely even by patients with severe liver disease, unlike oral or injectable naltrexone or disulfiram. Additionally, people who relapse while taking acamprosate may benefit from continuing the medication.

Who SHOULDN’T use acamprosate in alcohol withdrawal treatment?

Anyone who is found to be both medically and motivationally appropriate for acamprosate therapy and wants to try the medication should be given the opportunity. Acamprosate users develop no known tolerance or dependence. It also carries little overdose risk. Still, doctors should always assess medical appropriateness for therapy with acamprosate. Some conditions to consider include:

  1. People diagnosed with severe renal impairment (creatinine clearance <30 mL/min) should not use acamprosate.
  2. People diagnosed with moderate renal impairment (creatinine clearance 30–50 mL/min) may be able to take the medication with dosage adjustments and careful monitoring.
  3. People who report side effects that include depression and suicidal thoughts.
  4. People who drive or or operate heavy machinery should discontinue these activities until they know how acamprosate will affect their ability to do so.
  5. Women who are or become pregnant; use of acamprosate during pregnancy has not been
  6. studied with humans. Animal studies of acamprosate and pregnancy have found some potential fetal risk.

So, can acamprosate work for everyone? Research on specific characteristics as predictors of efficacy has not identified any particular characteristics to predict acamprosate treatment outcomes. However, evidence exists that acamprosate is most effective for people who, at treatment onset, are motivated for complete abstinence rather than decreased drinking.

Acamprosate help with alcohol withdrawal questions

Do you still have questions about acamprosate help with alcohol withdrawal? In case there is something you would like to know, please ask your question(s) in the comments section below. We at Addiction Blog will do our best to answer all legitimate questions with a personal and prompt response.

Reference Sources: NCBI: The effect of acamprosate on alcohol craving and correlation with hypothalamic pituitary adrenal (HPA) axis hormones and beta-endorphin
MedlinePlus: Alcohol withdrawal
SAMHSA Advisory: Acaprosate: A new medication for alcohol use disorders
MedlinePlus: Acamprosate
NCBI: Acamprosate
LiverTox: Acamprosate

Photo credit: Wiki Media Commons

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