Acamprol: Restoring Neurochemical Balance for Alcohol Dependence Management
| Product dosage: 333 mg | |||
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Synonyms | |||
Acamprol (acamprosate calcium) is a prescription medication specifically formulated to support the maintenance of abstinence in alcohol-dependent patients who have achieved initial withdrawal. It functions as a neuromodulator, targeting the glutamatergic and GABAergic systems believed to be dysregulated in chronic alcohol use. By helping to stabilize this neurochemical imbalance, Acamprol reduces the physiological distress and craving associated with post-acute withdrawal, thereby supporting long-term recovery. It is most effective when integrated into a comprehensive treatment program that includes counseling and psychosocial support.
Features
- Active ingredient: Acamprosate Calcium 333 mg (delivered as two 333 mg enteric-coated tablets per dose)
- Pharmacologic class: Synthetic endogenous amino acid homotaurine analogue; GABA receptor agonist and glutamate modulator
- Administration: Oral
- Formulation: Delayed-release enteric-coated tablets to ensure gastric stability
- Dosing schedule: Standard regimen of two tablets taken three times daily
- Prescription status: Schedule IV controlled substance (varies by jurisdiction)
Benefits
- Reduces the subjective experience of craving and desire for alcohol following detoxification.
- Helps to re-establish a baseline neurochemical state, mitigating the hyperglutamatergic activity associated with prolonged abstinence.
- Supports long-term abstinence rates when used as part of a comprehensive management plan.
- Demonstrates a favorable side effect profile with a low incidence of sedation or cognitive impairment.
- Is not metabolized by the liver, making it a suitable option for patients with compromised hepatic function.
- Lacks abuse potential and does not produce euphoria or a disulfiram-like reaction upon alcohol consumption.
Common use
Acamprol is indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation. It is not indicated for the treatment of acute alcohol withdrawal symptoms. The therapeutic goal is to reduce the relapse risk by managing the protracted withdrawal syndrome characterized by dysphoria, anxiety, insomnia, and alcohol craving. Treatment is typically initiated as soon as possible after the acute withdrawal period is complete and the patient has achieved abstinence.
Dosage and direction
The recommended dose of Acamprol is two 333 mg tablets (total 666 mg) taken three times daily. Although the tablets can be taken with or without food, taking them with meals may help patients remember their doses. The tablets must be swallowed whole and not crushed or chewed, as this will compromise the enteric coating. Dosage adjustment is recommended for patients with moderate renal impairment (creatinine clearance of 30-50 mL/min); the dose should be reduced to one 333 mg tablet three times daily. Acamprol is contraindicated in patients with severe renal impairment (creatinine clearance ≤30 mL/min).
Precautions
- Acamprol does not eliminate or diminish the intoxicating effects of alcohol.
- Patients should be advised to continue their participation in a comprehensive psychosocial support program.
- Renal function should be assessed before initiating treatment and periodically thereafter, especially in older patients or those with conditions predisposing them to renal impairment.
- Suicidal ideation and depression have been reported in patients undergoing treatment for alcohol dependence; patients should be monitored for the emergence or worsening of depression or suicidal thoughts.
- The safety and efficacy of Acamprol have not been established in patients under 18 years of age.
Contraindications
- Hypersensitivity to acamprosate calcium or any of the excipients in the formulation.
- Severe renal impairment (creatinine clearance ≤30 mL/min).
Possible side effect
The most common adverse reactions are gastrointestinal and dermatological. These are often transient and mild to moderate in intensity.
- Very Common (≥1/10): Diarrhea
- Common (≥1/100 to <1/10): Nausea, abdominal pain, vomiting, flatulence, itching (pruritus), rash, increased libido, impotence
- Uncommon (≥1/1,000 to <1/100): Fluctuations in libido, dry mouth, dizziness, paresthesia, increased sweating, weight gain
- Rare (<1/1,000): Bullous skin reactions, urticaria, visual disturbance, tinnitus
Drug interaction
Acamprol has a low potential for pharmacokinetic drug interactions as it is not metabolized by the cytochrome P450 system and does not induce or inhibit these enzymes. It is eliminated unchanged by the kidneys. However, potential pharmacodynamic interactions should be considered:
- Naltrexone: Coadministration may increase the incidence of diarrhea, nausea, and somnolence compared to either drug alone, though the combination is often used clinically.
- Antidepressants (e.g., SSRIs, TCAs): No known interactions, but the combined effects on mood should be monitored.
- Other CNS Depressants (e.g., benzodiazepines, opioids): Additive sedative effects are possible, though not commonly reported with acamprosate.
Missed dose
The patient should take the missed dose as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. The patient should not take a double dose to make up for a missed one.
Overdose
Experience with Acamprol overdose is limited. Doses of up to 56 grams have been reported and were associated with diarrhea but no other serious clinical events. In the event of a suspected overdose, standard supportive measures should be employed. There is no specific antidote for acamprosate. Due to its renal elimination, dialysis may be considered in cases of severe overdose, particularly in patients with renal compromise, though its efficacy is unknown.
Storage
Store Acamprol tablets at room temperature (15°C to 30°C or 59°F to 86°F). Keep the bottle tightly closed to protect from moisture. Keep out of the reach of children and pets. Do not use after the expiration date printed on the packaging.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
- Clinical Consensus: “Acamprosate remains a cornerstone pharmacotherapy in our arsenal for Alcohol Use Disorder. Its mechanism of action is unique and well-suited to managing the protracted withdrawal phase. Its efficacy is well-documented in numerous randomized controlled trials and meta-analyses, showing a significant increase in cumulative abstinence duration.” – Addiction Psychiatry Specialist
- Patient Feedback: “It didn’t make me feel different, but after a few weeks, I realized the constant ’noise’ and urge to drink had quieted down significantly. It gave me the mental space to focus on my therapy and rebuilding my life.” – Anonymous patient, 2 years sober.
- Research Summary: “A 2014 Cochrane review encompassing 24 randomized controlled trials concluded that acamprosate approximately doubles the rate of complete abstinence compared to placebo and significantly increases the number of patients maintaining continuous abstinence. Its effect on drinking reduction in patients who lapse is less pronounced.” – Systematic Review Analysis