Tuesday September 27th 2016

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Is acamprosate effective?

Yes.

Acamprosate (brand name Campral) is generally understood to be safe and effective in treating alcohol dependence and reducing relapse. It helps decrease alcohol craving by modulating and normalizing brain activity after a period of dependence…most notably by relieving symptoms of post-acute withdrawal (PAWS) such as insomnia, anxiety, and restlessness. Simply put, people who have used acamprosate in clinical trials “seem to lose interest in alcohol.”

So, how do experts think that acamprosate works in the brain and the body? Does it work for everyone? And, if acamprosate is a pill to help you stop drinking … can you improve its effectiveness? More on how this prescription medication works here. Then, we invite your questions about the effectiveness/use of acamprosate for alcoholism in the comments section at the end.

What is acamprosate used for?

Acamprosate (calcium acetyl homotaurinate) is a relatively new prescription medication that is prescribed to help people who are alcohol dependent. It seems to lessen alcohol cravings, and is prescribed for up to a year after a person first stops drinking. It is most effective when used as part of a comprehensive management program which includes psychosocial support.

Acamprosate is taken in oral tablet form as a delayed release medicine, and  peaks 3-8 hours after dosing. Because acamprosate does not undergo metabolism, it is eliminated from the body via the kidneys as an almost unchanged drug (90% intact). This is particularly helpful in cases of possible liver damage. Because it is minimally metabolized in the liver, its lack of hepatotoxicity can be helpful when treating long-term, chronic drinking. Note here that people diagnosed with severe renal impairment should not use it, although those with moderate renal impairment accompanied by dosage adjustments and careful monitoring can benefit from acamprosate.

Acamprosate effectiveness

So, how does acamprosate work? Here’s a little of the brain science behind it. Basically, when a person stops drinking alcohol, the brain enters an abnormal state of hyperexcitability. It is thought that acamprosate helps the brain regain balance. How?

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Our bodies constantly seek balance. A baseline equilibrium in the brain exists between excitatory neurotransmitters (glutamate and aspartate) and inhibitory neurotransmitters (gaba and taurine). When someone drinks, the effect is to decrease glutamate, increasing the process of inhibition to counter the sedative nature of alcohol. During alcoholic drinking, neuroadaption occurs as a biological process to try to maintain balance: up-regulation of the NMDA receptor occurs, which manifests as an increase in the number of receptors and an overall balance in the brain.

But, when someone who become physically dependent on alcohol stops drinking and goes into alcohol withdrawal, the brain experiences an increase in glutamate (excitation is dominant).  This results in hyperactivity of the central nervous system. Acamprosate is thought to work by inhibiting NMDA receptors while activating GABA receptors. It binds on glutamate receptors, inhibiting glutamate’s release, thus decreasing the degree of excitation or withdrawal.

The result?

Acamprosate may restore the balance in the brain between the excitatory neurotransmitters (glutamate and aspartate) and the inhibitory neurotransmitters (gaba and taurine) that usually can take up to 12 months to normalize on its own. This can ease symptoms of acute and protracted alcohol withdrawal significantly. Still, acamprosate’s mechanism of action is not clearly established and experts are still exploring how it works.

The main effects of acamprosate are:

  1. balanced brain chemistry
  2. decreased alcohol cravings
  3. decreased anxiety
  4. decreased insomnia
  5. decreased restlessness

Acamprosate effectiveness time

It can take 5 to 8 days before acamprosate is fully effective. Manufacturers suggest that treatment with acamprosate should begin as soon as possible after alcohol withdrawal and maintained during relapse. The recommended dose is two 333 mg tablets taken three times daily. However, a lower dose may be effective in some patients.

Signs that acamprosate is working

You can usually know that acamprosate is working if/when you are no longer interested in drinking. Common side effects that indicate acamprosate in the system are usually mild and transient, lessening or disappearing within the first few weeks of treatment (the most common of which is diarrhea). Other common side effects can include:

  • anxiety
  • dizziness
  • insomnia
  • itchiness
  • muscle weakness
  • nausea

How effective is acamprosate?

Acamprosate can be a very helpful aid to avoid cravings in the first 3-12 months of quitting drinking. However, medications such as acamprosate for alcohol use disorders should not replace counseling.  In order to make acamprosate most effective, experts recommend that you continue counseling and 12-Step or mutual-help group participation to increase your chances for long term sobriety. Seek ongoing motivational counseling specifically geared to helping you meet your individual needs.

How to make acamprosate more effective

Clinical trials have identified that good candidates for acamprosate are:

  • committed to seeking concurrent psycho-social therapies
  • interested in trying the medication
  • motivated to maintain total abstinence
  • willing and able to take acamprosate regularly as prescribed

A generally stops taking acamprosate /she has achieved stable abstinence from alcohol, has less intense cravings, and has established a sound plan and support for ongoing recovery. Because taking the medication three times a day can be tough to remember, some other practical tips include:

1. Set alarms as a reminder to take your tablets.
2. Take acamprosate with meals.
3. Use pill boxes to set up a dosing regiment.

Barriers to acamprosate effectiveness

Acamprosate should not be discontinued just because a patient slips or relapses. However, there are some cases when acamprosate may just not work for you. For example, the medication should be used with pregnant or lactating women only when potential benefits justify potential risk to the fetus or infant.

Furthermore, depression and suicidal thoughts are uncommon but should be taken seriously. Patients on acamprosate should be monitored for symptoms of depression or suicidal thinking and treated immediately. Other barriers to the effectiveness of acamprosate can include:

  • concerns about side effectsmedication compliance issues
  • desire to stop taking the medication
  • reported or detected drinking or drug use episodes
  • reported or observed increase in levels of depression or anxiety
  • significant physical complaints
  • suicidal ideation

Efficacy of acamprosate

For more on clinical studies, reviews, and general acceptance of scientific community about the efficacy of acamprosate, check out our references sources for more information.

Acamprosate effectiveness questions

Do you have additional questions about acamprosate? Please leave your questions here. We’ll do our best to respond to you personally and promptly.

Reference Sources: SAMHSA KAP Learning
PubChem: Acamprosate
DailyMed: Campral
Canadian Drug Bank: Acamprosate
NIAAA: FAQ
LiverTox: Acamprosate
Substance Abuse Treatment Advisory: Acamprosate
OASES: Addiction Medications

Photo credit: DailyMed

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