II. Indications

  1. Maintenance of Alcohol abstinence

III. Contraindications

  1. Severe Renal Insufficiency (CrCl <30 ml/min)
  2. Advanced Cirrhosis (although appears safe in most with impaired hepatic function)

IV. Mechanism

  1. Balances GABA and glutamate neurotransmitters
    1. Blocks glutaminergic N-methyl-D-Aspartate receptors
    2. Activates GABA Type A receptors
  2. Reduces anxiety from abstinence

V. Efficacy

  1. Reduces short and longterm relapse rates
  2. Sustains Alcohol abstinence (NNT 12) and reduces Problem Drinking (NNT 9)

VI. Dosing

  1. Campral 666 mg (two 333 mg tabs) orally three times daily
    1. Start with one three times daily
    2. Increase with one additional tablet daily each week
    3. Slow titration reduces gastrointestinal side effects
  2. Indications to decrease to 333-666 mg AM, 333 noon, 333 PM
    1. Weight <60 kg
    2. Renal Insufficiency
      1. Creatinine Clearance <50 ml/min, but >30 ml/min
      2. Contraindicated if Creatinine Clearance <30 ml/min

VII. Drug interactions

  1. No interaction with Alcohol or Benzodiazepines
  2. No interaction with Disulfiram (Antabuse)

VIII. Safety

  1. Pregnancy Category C
  2. Lactation: Unknown

IX. Adverse effects

  1. Transient Diarrhea (10%) and other gastrointestinal symptoms (Flatulence, Nausea)
  2. Insomnia
  3. Depressed mood
  4. Pruritus
  5. Paresthesias
  6. Diaphoresis

X. Disadvantages

  1. Cost: $150/month trade name (but generic available for $55 per month)

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Cost: Medications

acamprosate (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
ACAMPROSATE CALC DR 333 MG TAB Generic $1.06 each

Ontology: acamprosate (C0284941)

Definition (CSP) calcium salt of N-acetylhomotaurine; an adjunct to psychotherapy in maintaining abstinence after alcohol withdrawal in patients with alcohol dependence.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH C043877
SnomedCT 420804003, 391698009
LNC MTHU047786, LP182301-4
English AOTA, Acamprosate, Acamprosate (product), acamprosate (medication), Acamprosate (substance), Acamprosate - chemical, Acamprosate - chemical (substance), acamprosate [Chemical/Ingredient], ACAMPROSATE, acamprosate, acamprostate, N-acetylhomotaurine
Spanish acamprosato, acamprosato (producto), acamprosato - sustancia química (sustancia), acamprosato (sustancia), acamprosato - sustancia química

Ontology: Campral (C0592792)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C043877
English Campral, Campral EC, Alphapharma brand of acamprosate calcium, Lipha brand of acamprosate calcium, Merck brand of acamprosate calcium, AWD.pharma brand of acamprosate calcium