Acamprosate

Updated 26/04/20

Acamprosate, also known as Campral, is a medication that is used as an accompaniment to therapy for the treatment of alcohol dependence and alcoholism.

In 2014, acamprosate calcium tablets (Campral) was the most commonly prescribed drug for treating alcohol dependence in England, with 139,000 prescriptions being dispensed (1)

Since its introduction onto the European market in 1989, Acamprosate for alcohol dependence. has been used to treat over 1.5 million patients (2)

Today it is still viewed as a successful alcohol treatment drug and is prescribed as a first-line drug along with naltrexone before disulfiram (Antabuse) is considered.

Here we examine the possible benefits of acamprosate, what it actually is and how it works, the negative side effects of the drug and who should and shouldn’t take it.

What is acamprosate (Campral)?

Sold under the brand name Campral, this is a pharmaceutical medication used in conjunction with alcohol counselling to treat alcohol dependence and alcoholism (3)

Acamprosate is not meant to be used as a stand-alone treatment for alcoholism for a number of reasons. It does not cure alcoholism or alcohol dependence. It can however be a useful tool in treating alcohol use disorders (AUD) when combined with professional alcohol counselling and therapy.

Acamprosate is prescribed to alcohol-dependent individuals, to support complete abstinence from alcohol once the individual has managed to stop drinking.

It is considered a safe and generally well-tolerated drug. It has undergone numerous clinical trials worldwide before its introduction to the UK as a pharmacotherapy (pharmaceutical drug treatment) (2)

Indications for Campral dosage and prescribing

The usual recommended dosage of Campral for patients who suffer from alcohol dependence is one 333 mg tablet a day up to 3 times a day depending on weight although lower 333 mg doses have been found to be just as effective in some patients.

Lower doses may also be considered on an individual basis for patients that suffer from renal impairment, or who are at higher risk of suffering the more severe side effects of the drug (4)

Campral comes in delayed-release gastro-resistant tablet that is swallowed. The indications for the duration of treatment vary from patient to patient, but it is recommended that the treatment is continued even if the patient relapses on alcohol (4)

Acamprosate / Campral – What it does and how it works

Acamprosate (Campral) works by reducing physical cravings for alcohol. When combined with psychotherapy, the long-term goal is to achieve and support complete alcohol abstinence.

Hailed as an ‘anti-alcohol craving drug’, acamprosate is prescribed to help prevent alcoholic relapse. However, it does not treat the psychological aspect of alcoholism, and this is why it should never be used as a stand-alone treatment.

While Campral can be used for patients with alcohol dependence. It does not diminish or treat alcohol withdrawal symptoms. This is important, as an alcohol-dependent patient will require some form of alcohol withdrawal treatment (alcohol detox) before commencing Campral therapy (4)

How Acamprosate works – The science behind the treatment

Acamprosate is an analogue of amino acid neurotransmitters such as taurine and homocysteine acid.  Studies have demonstrated that acamprosate binds to a specific spermidine-sensitive site that regulates the NMDA receptor in a complex way (5)

The effect  on the NMDA receptor suggests that acamprosate acts as a ‘partial co-agonist’ on the NMDA receptor in the brain.

During the early abstinence from alcohol or following on from an alcohol detox, the NMDA receptors are far more active than normal. This results in symptoms such as insomnia, anxiety and alcohol cravings. In contrast to this abnormal overactivity of the NMDA receptors, Acamprosate promotes the release of taurine in the brain (6,7)

Taurine is a major inhibitory neurotransmitter. The increase in taurine that Acamprosate produces helps to regulate the NMDA receptors hyperactivity, thus reducing symptoms associated with early recovery from alcohol dependency (8)

Alcohol cravings, anxiety and insomnia are well-known triggers for relapse. During early recovery, these symptoms are at their most severe, when a recovering alcoholic is at their most vulnerable.

By using Campral to regulate the brain’s activity and reduce these symptoms, the brain has time to naturally readjust to being without alcohol (9)

The difference between Acamprosate, Naltrexone and Disulfiram

Acamprosate, naltrexone and disulfiram (Antabuse) are all pharmaceutical drugs clinically approved to support complete abstinence from alcohol – but they all work in very different ways.

All three drugs are not intended to be a stand-alone treatment for alcohol dependency and should always be combined with counselling and therapy.

  • Acamprosate (Campral) works by reducing cravings for alcohol, once alcohol abstinent.
  • Naltrexone works by blocking the effects that alcohol has on the brain (thus making drinking alcohol pretty pointless)
  • Disulfiram (Antabuse) is a deterrent therapy and causes a violent physical reaction when mixed with even the smallest amounts of alcohol.

A patient may choose to take more than one alcohol pharmacological treatment out of the three if they and their doctor agrees it would be beneficial.

All three drugs work very well in conjunction with therapy. Acamprosate is more cost-effective and tends to be regarded as safer than naltrexone and disulfiram and therefore is usually the first in line for alcohol dependence treatment.

Disulfiram (Antabuse) carries the most risks and therefore is the last in line of the three treatments.

With Campral and naltrexone, no adverse effects are shown if mixed with alcohol, but with disulfiram, the risks are very great and can even result in death. (10)

Acamprosate side effects

As with most pharmaceutical drugs, Acamprosate carries some unwanted side effects.

While Campral is generally very well tolerated by most patients and is considered one of the safest pharmacological treatments for alcoholism. Patients may experience any of the following adverse side effects:

  • anxiety
  • diarrhoea
  • depression
  • nausea
  • vomiting
  • stomach ache
  • loss of appetite
  • headache
  • drowsiness
  • feeling faint
  • vision disturbances
  • cognitive and memory impairment
  • constipation
  • lethargy
  • weight gain or weight loss
  • aching muscles and joints
  • cold or flu-like symptoms
  • dry mouth
  • alterations in the sense of taste and smell
  • insomnia
  • excessive sweating
  • numbness and pins and needles
  • impotence and change in libido
  • Increased suicidal thoughts in those that suffer from depression (11)

It is important to remember that not everyone will experience side effects. Those that do may well find that side effects diminish with the continuation of the treatment or a reduction in dosage.

If any side effects become very troublesome, counterproductive or dangerous, discontinuation of the medication is recommended. 

Who should NOT take Acamprosate / Campral

Campral is not suitable for everyone that suffers from alcohol dependence. An individual’s suitability should only be assessed by a qualified doctor or psychiatrist, familiar with the patient’s entire medical history to date.

What happens if you drink while taking acamprosate?

Campral is not recommended for alcohol-dependent individuals that are still drinking. Nor is it recommended for those that are under 18 years of age, or those who are not committed to undergoing alcohol rehabilitation therapy. In patients that suffer renal impairment, extra caution should be taken.

Campral has NOT been proven to work in those that suffer from polydrug use, and even if they have stopped drinking (11), This is because the effects of another active drug addiction will counteract any benefits that Campral has to offer.

In patients that suffer from any form of clinical depression, have previously experienced suicidal or self-harm tendencies, suffer from renal impairment or are elderly – regular medical monitoring is required (11)

How does acamprosate work

Acamprosate is most beneficial to those that have already stopped drinking but who have previously suffered from an alcohol use disorder, in particular alcohol dependence.

While some individuals may find that this medication helps them to reduce their binge drinking, clinically, it is only recommended for those that have already undergone an alcohol detox and need additional treatment to prevent relapse.

Campral may particularly benefit those that have previously been alcohol dependent, detoxed and relapsed. When used in conjunction with alcohol treatment therapy and alcohol rehabilitation, it can help to reduce the desire for alcohol by stabilising the brains over-activity (8,11)

How long does it take for acamprosate to work?

Acamprosate takes around a week to start working. During this time additional support should be put in place (12)

It is recommended that treatment can start once alcohol withdrawal symptoms have subsided. How long a patient stays on treatment for can vary from person to person.

Once alcohol consumption has ceased, an alcohol dependent brain can take 6 months to a year, sometimes longer to recover. The newly sober person also needs time and support to adapt to their new alcohol-free lifestyle (12)

Campral only helps to diminish alcohol cravings, and it does not address the underlying issues or the behaviours that contributed to active alcoholism. This is why psychotherapy is a vital part of this treatment.

Once a patient is comfortable in their sobriety, has addressed the issues that underpin their addiction with a professional, has a network of support groups in place and a means through which they can maintain their sobriety, together with their doctor and counsellor they can discuss the discontinuation of the treatment (12)

Means of maintaining sobriety may include an alcohol recovery programme or a mutual aid group such as Alcoholics Anonymous.

Every individual is different, and this is why the decision to discontinue treatment should be medically guided in accordance with the individual’s progress in sobriety.

Therapies that compliment Acamprosate / Campral treatment

Acamprosate medications work best when combined with addiction targeted therapy and an alcohol support network.

Many therapies have proven to help treat alcohol addiction. These evidence-based therapies can be delivered within a rehab setting as part of an intensive alcohol rehabilitation programme, or in the community by a counsellor or psychotherapist experienced in treating addiction.

Evidence-based therapies proven to help treat alcohol addiction and dependence include:

  • Cognitive behavioural therapy – CBT
  • Integrative therapy
  • Trauma therapy
  • Person-centred therapy
  • Dialectical behavioural therapy – DBT
  • Psychotherapy
  • Relapse prevention techniques

Any therapy the patient undergoes should address all aspects of them as an individual and not just the drinking.

Therapy should focus on behaviours, thought processes, social interaction, physical recovery, family recovery, boundaries, personal development and growth, personal responsibility and spiritual development.

Issues connected to finances, housing and personal relationships should also be addressed for the best possible long-term outcome.

Can Acamprosate / Campral work for anyone?

Acamprosate can only work for those that are trying to maintain an alcohol-free life and are committed to change with the help of professional therapy.

Campral is not a magic pill, and it does not cure alcoholism or treat active alcohol dependency. While it does not guarantee against alcoholic relapse, it is a useful tool for those that struggle to maintain complete abstinence and have tried other methods that have not worked before.

If you are sick of being sick and are looking for a treatment that can support you once you have undergone a full alcohol detox, together with therapy, Acamprosate could work for you in maintaining abstinence from alcohol.

Are you battling drug or alcohol addiction? Do you suffer from chronic alcoholism? Are you ready to reclaim your life?

Rehab Guide can help you find a safe and comfortable place to heal. By offering a tailored approach, our residential treatment centres heal the entire person, increasing the likelihood of success.

Contact us today by email or phone 02072052845 for more information and help.

 

 

 

 

 

 

References:

 

  • Drugs for treating alcohol dependence -BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3670 (Published 01 July 2016)
  • Treatment of alcohol-dependent outpatients with acamprosate: a clinical review.Mason BJJ Clin Psychiatry. 2001; 62 Suppl 20():42-8.
  • Plosker, GL (July 2015). “Acamprosate: A Review of Its Use in Alcohol Dependence”. Drugs. 75 (11): 1255–68.
  • Ethanol and amino acids in the central nervous system: assessment of the pharmacological actions of acamprosate. Dahchour A,
  • De Witte P. Prog Neurobiol. 2000 Mar; 60(4):343-62.
  • Acamprosate (calciumacetylhomotaurinate) decreases postsynaptic potentials in the rat neocortex: possible involvement of excitatory amino acid receptors. Zeise ML, Kasparov S, Capogna M, Zieglgänsberger WEur J Pharmacol. 1993 Jan 26; 231(1):47-52.
  • Central effects of acamprosate: part 1. Acamprosate blocks the glutamate increase in the nucleus accumbens microdialysate in ethanol withdrawn rats. Dahchour A, De Witte P, Bolo N, Nédélec JF, Muzet M, Durbin P, Macher JP Psychiatry Res. 1998 May 20; 82(2):107-14.
  • Increased glutamatergic neurotransmission and oxidative stress after alcohol withdrawal. Tsai GE, Ragan P, Chang R, Chen S, Linnoila VM, Coyle J. Am J Psychiatry. 1998 Jun; 155(6):726-32.
  • Acamprosate (calciumacetylhomotaurinate) decreases postsynaptic potentials in the rat neocortex: possible involvement of excitatory amino acid receptors .Zeise ML, Kasparov S, Capogna M, Zieglgänsberger W. Eur J Pharmacol. 1993 Jan 26; 231(1):47-52.
  • WHO – World Health Organisation https://www.who.int/mental_health/mhgap/evidence/resource/alcohol_q4.pdf?ua=1
  • RX List drugs Campral – https://www.rxlist.com/campral-side-effects-drug-center.htm
  • https://www.sahealth.sa.gov.au/wps/wcm/connect/0ee53b804089872582f0ba222b2948cf/

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