Acamprosate (Campral) Side Effects, Dosage and Cost


About Acamprosate

Acamprosate is a medication most commonly used to treat alcohol use disorder.1 When used safely, this medication can help people struggling with alcoholism to achieve and maintain abstinence.


What Is Acamprosate?

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Acamprosate is a medication approved by the Food and Drug Administration for the treatment of alcohol use disorder.2 It helps people achieve and maintain abstinence from alcohol by reducing cravings and preventing relapse.1 It is the preferred treatment for those whose goal is complete abstinence, not reduced-risk drinking.2 Acamprosate does not reduce or eliminate withdrawal symptoms.

Acamprosate is not a cure for alcohol use disorder . 4 It is most effective if combined with psychosocial interventions such as cognitive behavioral therapy and motivational interviewing . 5 Twelve-step programs such as Alcoholics Anonymous can also be helpful because they provide an opportunity for you to bond with people who have similar struggles. 5

How Does It Work?

Acamprosate works by rebalancing the amount of excitatory and inhibitory signals in the brain.2

Communication within the nervous system is mediated by signaling chemicals known as neurotransmitters. These neurotransmitters can be classified as either excitatory or inhibitory, depending on how they affect brain cells.3 When balanced, these neurotransmitters keep your brain and body working correctly. However, too much of either can lead to seizures, stroke, coma or death. 3

Long-term alcohol abuse causes your brain to produce too many excitatory and too few inhibitory neurotransmitters.3 It teaches your brain that it no longer needs to produce its own inhibitory signals because you will supply them yourself with alcohol.3

By blocking an excitatory receptor called N-methyl-D-aspartate (NMDA), acamprosate reduces the excess of excitatory messages and increases the amount of inhibitory messages. 2 For this reason, some experts refer to acamprosate as "artificial alcohol."2 Ultimately, acamprosate helps reduce cravings and prevent relapse . 1

Where Can You Get It?

Physicians and nurse practitioners can prescribe it.
Both nurse practitioners and physicians can prescribe acamprosate.4 In some states, physician assistants and psychologists can prescribe it as well.4

Your primary care provider can prescribe this medication. But it is usually best to receive care from an addiction medicine specialist - specifically a psychiatrist or a psychiatric nurse practitioner at either a mental health or a substance abuse clinic.4

Acamprosate should only be taken under the guidance of a medical professional.


Acamprosate Side Effects

Common side effects of acamprosate include:

  • Itchy skin.
  • Diarrhea.
  • Flatulence.
  • Nausea.
  • Dizziness.
  • Insomnia.
  • Anxiety.
  • Depression.1

Up to 17% of users report diarrhea after taking acamprosate, making it the most common side effect. 1 Other potential side effects include weight gain and sedation. However, these are rare.2

Serious Adverse Effects

Serious adverse effects include:

  • Cardiomyopathy (the heart struggles to deliver blood to the body - can lead to heart failure).
  • Deep thrombophlebitis (inflammation of veins due to a blood clot).
  • Heart failure.
  • Mesenteric arterial occlusion (blockage of the arteries that supply blood to the digestive tract).1

About 1% to 2.4% of users experience suicidal ideation while taking acamprosate. 1 This is more likely to occur if those who have attempted suicide in the past. 1 It will be important to discuss symptoms with your healthcare provider if you begin to feel down, depressed or hopeless while taking Acamprosate.

Acamprosate appears to be safe for long-term use. However, extensive research on this has not been conducted. 1

Allergic Reactions

As with any new medication, you may be at risk of developing an allergic reaction when acamprosate therapy is initiated.

Symptoms of an allergic reaction to acamprosate include:

  • Sudden, raised red spots on your body.
  • Itching.
  • Stomach pain.
  • Nausea.
  • Vomiting.
  • Swelling of the throat, mouth, lips or tongue.
  • Difficulty breathing.
  • Feeling lightheaded, weak, confused and restless.1
If you think you are experiencing an allergic reaction, you should stop taking acamprosate and call your healthcare provider immediately.


Dosage Information

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Acamprosate comes in 333 mg tablets.2 It is most commonly prescribed as 666 mg tablets taken 3 times per day.2 If you have mild to moderate kidney problems, your healthcare provider may reduce the dose to 333 mg to be taken 3 times per day.2

You cannot take acamprosate if you have severe kidney problems,2 and it is not recommended for use during pregnancy.2

Research demonstrates that you should take acamprosate for 3 to 12 months to achieve the best results. 2 Although not required, most healthcare providers will encourage you to take each dose with a meal: one with breakfast, one with lunch and one with dinner. 2

If you miss a dose, wait until your next scheduled dose. You should never take extra doses to make up for a missed dose.2


Drug Interactions

Avoid alcohol while taking acamprosate.
Acamprosate does not have any serious drug interactions, and you can start taking it as soon as you achieve abstinence or complete a detoxification program .2, 4

If you are taking naltrexone with acamprosate, your blood levels of acamprosate will increase. But this does not appear to have any clinical significance.2

Avoid alcohol when taking this medication. However, if you do relapse, continue taking acamprosate as prescribed and call your healthcare provider. 2


Acamprosate Cost

Acamprosate's cost varies by insurance type. But it is often partially covered by insurance.2 The price usually ranges from $100 to $200 per month.2 Sometimes insurance companies will require a prior authorization before they will cover acamprosate.2
This is a form your healthcare provider fills out that documents whether you meet certain criteria. For example, your insurance company might want to know that you are undergoing psychotherapy in addition to taking acamprosate before they will cover it.


How Effective Is It?

Several studies have examined acamprosate's effectiveness.

  • A 2010 study demonstrated that acamprosate was beneficial in the management of alcohol use disorder by reducing cravings and helping to maintain abstinence.6 This study analyzed the results of 24 randomized controlled trials with a total of 6,894 alcohol-dependent patients. The review concluded that acamprosate reduces the risk of relapse after a person completes an alcohol detox program and that this medication works best for those who are already abstinent and who intend on remaining abstinent.
  • Another systemic review published in 2014 compared acamprosate to naltrexone (another medication used to treat alcoholism) and their effects on a person's likelihood of returning to drinking after undergoing an alcohol detoxification program.7 The review included 122 randomized-controlled trials and 22,803 participants. This study found that both medications equally reduced a person's risk of returning to drinking.
  • Additionally, a 2008 meta-analysis also compared acamprosate to naltrexone.8 This study concluded that acamprosate was more effective at helping people maintain abstinence, while naltrexone was more effective at preventing relapses for heavy, binge drinking.

Find an Alcohol Abuse Treatment Program

Alcohol abuse can have serious consequences to your health, your loved ones and your future. Fortunately, a variety of effective treatment options are available, including acamprosate therapy.

If you or someone you know is interested in a treatment program for alcoholism, please call our free, 24-hour helpline at 1-888-319-2606Who Answers? . We can verify your insurance and determine treatment coverage. If you do not have insurance, please call the Substance Abuse and Mental Health Services Administration's (SAMHSA) national helpline at 1-888-319-2606Who Answers? (HELP).

Sources

[1]. Chisholm-Burns, S., Schwinghammer, T., Wells, B., Malone, P., & DiPiro, J. (2013). Pharmacotherapy principles and practice (3rd ed.). New York, NY: McGraw-Hill Medical.

[2]. Stahl, S. M. (2014). Prescriber's guide: Stahl's essential psychopharmacology (5th ed.). New York: NY: Cambridge University Press.

[3]. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

[4]. Gabbard, G. O. (2014). Gabbard's treatments of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Association.

[5]. Jhanjee, S. (2014). Evidence based psychosocial interventions in substance abuse . Indian Journal of Psychological Medicine. 36(2),112-118. doi: 10.4103/0253-7176.130960

[6]. Rosner, S., Hackl-Herrwerth, A., Leucht, S., Lehert, P., Vecchi, S., & Soyka, M. (2010). Acamprosate for alcohol dependence . Cochrane Database of Systematic Reviews. 2010(9), CD004332. doi: 10.1002/14651858.CD004332.pub2

[7]. Jonas, D. E., Amick, H. R., Feltner, C., Bobashev, G., Thomas, K., Wines, R., Garbutt, J.C. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis . JAMA. 311(18), 1889-1900. doi: 10.1001/jama.2014.3628

[8]. Rosner, S., Leucht, S., Lehert, P., & Soyka, M. (2008). Acamprosate supports abstinence, naltrexone prevents excessive drinking: evidence from a meta-analysis with unreported outcomes . Journal of Psychopharmacology. 22(1), 11-23.

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