Acamprol: Clinically Proven Relief for Alcohol Dependence
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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 is a cornerstone of pharmacological management in addiction medicine, working by helping to rebalance disrupted brain neurotransmission associated with chronic alcohol use. By targeting the underlying neurochemical imbalance, Acamprol aids in reducing the psychological distress and craving that often lead to relapse, facilitating a more stable recovery pathway as part of 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).
- Mechanism of Action: Modulates the glutamatergic system, acting as a functional antagonist at NMDA receptors and a partial agonist at GABA receptors to restore neurochemical equilibrium.
- Pharmaceutical Form: Enteric-coated, delayed-release tablets for optimal gastrointestinal tolerance and consistent systemic delivery.
- Prescription Status: Schedule IV controlled substance, requiring a prescription from a licensed healthcare provider.
- Treatment Protocol: Designed for long-term use as part of a comprehensive management plan for alcohol dependence.
Benefits
- Promotes sustained abstinence from alcohol by mitigating the physiological craving and desire to drink.
- Helps renormalize central nervous system function altered by chronic alcohol exposure, reducing hyperexcitability during early recovery.
- Supports psychological well-being by decreasing the distress associated with abstinence, such as dysphoria and anxiety.
- Demonstrates a favorable safety and tolerability profile for long-term pharmacotherapy, with no abuse potential or sedative effects.
- Complements behavioral interventions and counseling, enhancing the overall efficacy of a multi-modal treatment approach.
- Provides a non-dopaminergic mechanism of action, making it a suitable option for a wide patient demographic.
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 most effective when integrated into a comprehensive management program that includes psychosocial support, such as cognitive-behavioral therapy (CBT), motivational enhancement therapy, or participation in support groups like Alcoholics Anonymous (AA). Treatment should be initiated as soon as possible after the period of alcohol withdrawal, once physical withdrawal symptoms have subsided. It is not indicated for the treatment of acute alcohol withdrawal symptoms.
Dosage and direction
The recommended dosage of Acamprol for most patients is two 333 mg tablets (total 666 mg) taken three times daily. This can be abbreviated as “2 tablets TID.”
- Administration: Tablets should be swallowed whole with a glass of water. Do not crush, break, or chew the enteric-coated tablets.
- Timing: May be taken with or without food, though taking it with meals may help some patients remember doses.
- Renal Impairment: Dosage adjustment is required for patients with moderate renal impairment (creatinine clearance 30-50 mL/min). The recommended dose is one 333 mg tablet three times daily. Acamprol is contraindicated in patients with severe renal impairment (creatinine clearance ≤30 mL/min).
- Treatment Duration: Treatment should be maintained even in the event of a lapse (a single episode of drinking). The optimal duration of maintenance therapy is individualized but often continues for 6 to 12 months or longer, as determined by the treating physician.
Precautions
- Acamprol does not eliminate or diminish the symptoms of alcohol withdrawal. Patients must be through the acute withdrawal phase before starting therapy.
- Use with caution in patients with a history of depression or suicidal ideation, as alcohol dependence is itself associated with an increased risk of depression and suicide. Patients should be monitored for the emergence or worsening of depression.
- While Acamprol itself does not cause sedation or interact with alcohol, a return to drinking while on treatment will not be prevented and will produce its typical intoxicating effects.
- Contains calcium; each 333 mg tablet contains approximately 0.15 mEq of calcium. This should be considered in patients on calcium-restricted diets or with conditions like hypercalcemia.
- The safety and efficacy of Acamprol have not been established in the pediatric population or in patients over 65 years of age with hepatic impairment.
Contraindications
- Hypersensitivity to acamprosate calcium or any of the excipients in the formulation.
- Severe renal impairment (creatinine clearance ≤30 mL/min).
Possible side effect
Acamprol is generally well-tolerated. The most commonly observed adverse reactions are gastrointestinal and are often transient.
- 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, fatigue, paresthesia, increased sweating.
- Rare (<1/1,000): Suicidal ideation and attempts.
Drug interaction
- No clinically significant pharmacokinetic interactions have been observed with antidepressants (e.g., fluoxetine, imipramine), anxiolytics (e.g., diazepam), hypnotics (e.g., pentobarbital), or disulfiram.
- As Acamprol is not metabolized by the hepatic cytochrome P450 system and is eliminated unchanged by the kidneys, it has a low potential for pharmacokinetic drug-drug interactions.
- Concomitant use with naltrexone may lead to an increase in acamprosate plasma concentrations; however, the clinical significance of this is unknown.
Missed dose
If a dose is missed, the patient should take it as soon as they remember. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not take a double dose to make up for a forgotten one. Maintaining the regular TID schedule is important for stable drug levels and efficacy.
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, symptomatic and supportive care is the mainstay of treatment. Due to the drug’s renal elimination, dialysis may be considered, though its efficacy in removing acamprosate is not well established.
Storage
- Store at room temperature between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F).
- Keep the medication in its original blister pack to protect it from moisture.
- Keep out of reach of children and pets.
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
“Acamprol has been a vital component of our clinic’s relapse prevention protocol. Its specific mechanism targeting glutamate/GABA balance addresses a core pathophysiology of craving. We observe its greatest benefit in motivated patients who are engaged in concurrent therapy, where it significantly reduces the background anxiety and urge to drink.” – Addiction Psychiatrist, 15 years of experience.
“In my practice, Acamprol is a first-line pharmacotherapy due to its favorable side effect profile and lack of abuse potential. It is particularly useful for patients who cannot tolerate naltrexone or for whom a non-opioidergic agent is preferred. Patient adherence is generally high with the TID dosing schedule.” – Certified Addiction Medicine Specialist.
“Clinical trials and meta-analyses consistently place acamprosate among the most efficacious medications for supporting abstinence, with a number needed to treat (NNT) that is highly favorable. Its effect is robust in reducing ‘return to any drinking’ outcomes, making it a cornerstone of evidence-based treatment.” – Research Pharmacologist specializing in neuropsychopharmacology.