Acamprosate is a Food and Drug Administration-approved medication for alcohol use disorder.
Acamprosate is the first line of treatment for people with AUD. It is generally most effective for people who want to completely abstain from drinking. Evidence suggests that acamprosate restores the balance of certain chemicals within the brain.
The most common side effect of acamprosate is diarrhea. This usually is mild and goes away after a few weeks. While it may be more severe and persistent in some patients, it can be managed with antidiarrheal medications.
Acamprosate, marketed under the brand name Campral, is a medication that treats alcohol use disorder (AUD) by easing symptoms experienced by those who stop drinking.
Taken as a one- or two-pill dose three times a day, this medication is best for people who have already achieved a period of abstinence from alcohol and want to maintain their recovery. That said, it can be safely started in patients who recently stopped drinking or who are still drinking and trying to cut down.
Recovery from alcohol dependence is possible, and acamprosate may help.
Acamprosate, also known as acamprosate calcium, received Food and Drug Administration (FDA) approval in 2004 for use in medication treatment for AUD. Naltrexone and disulfiram are the other FDA-approved medications for AUD. Evidence shows that acamprosate can help people who have AUD and have stopped drinking with maintaining their sobriety.
Medication for AUD (MAUD) programs combine medications such as acamprosate with short-term or intensive counseling and/or behavioral therapies to assist in adjusting to life in recovery. Formerly known as medication-assisted treatment (MAT) programs, MAUD programs can help you stay motivated to remain in recovery and, if needed, address other physical and mental health issues.
Uses. Acamprosate is the first line of treatment for people with AUD who want to stop alcohol use. Acamprosate relieves symptoms (such as cravings) in the period soon after stopping alcohol use. As part of an MAUD plan, people typically start acamprosate after abstaining from drinking for five to 14 days. However, the medication can be safely started while the patient is still drinking.
Acamprosate comes in 333-milligram tablets. A one- or two-pill dose is taken by mouth three times a day.
Benefits. Patients have the best outcomes with acamprosate if they have achieved a period of abstinence from alcohol and wish to maintain their abstinence. Acamprosate is often used by people with AUD who are reintegrating back into the community after inpatient treatment or incarceration.
People who benefit the most from this type of AUD therapy tend to be those who drink to “relieve” symptoms of withdrawal from alcohol. Evidence shows that acamprosate can help those who are losing sleep due to alcohol withdrawal, cravings for alcohol, or a co-occurring condition such as post-traumatic stress disorder.
Acamprosate is generally most effective for people who want to completely abstain from alcohol use. By contrast, naltrexone, another medication for treating AUD, is most effective for people with moderate to severe dependence on alcohol whose aim is to reduce their frequency of heavy drinking. Acamprosate also differs from both naltrexone and disulfiram in that it doesn’t pass through or damage the liver. That can make it the best AUD treatment option for people who have liver disease.
Acamprosate is considered safe for people taking opioids as well as many other medications. And because acamprosate doesn’t interact with other medications used in withdrawal management, acamprosate can be started during a monitored withdrawal period and continued if a person resumes using alcohol.
Mechanism of action. Acamprosate’s mechanism of action is not well known. Evidence suggests that acamprosate restores the balance of excitatory (“upper”) and inhibitory (“downer”) chemicals in the brain. It therefore may compensate for the effects of alcohol withdrawal felt by those with a history of heavy drinking. These effects may include joint pain, anxiety, and insomnia. Note that “heavy drinking” is defined as more than four daily or 14 weekly drinks for men, and more than three daily or seven weekly drinks for women. However, acamprosate can be effective even for people who don’t have a history of heavy drinking.
What is the most effective medication for AUD?
There are three major medications for AUD: acamprosate, disulfiram, and naltrexone. The best AUD treatment medication for you depends on your health goals, medical conditions, and medical history.
Acamprosate is generally seen as most effective for people who are already abstaining from drinking and people who are using opioids or other medications that interact poorly with naltrexone.
Disulfiram is most effective when its use by otherwise healthy, alcohol-free patients is closely monitored and paired with counseling and education. It is considered a second-line treatment, after acamprosate and naltrexone.
Naltrexone generally works best for people with moderate to severe dependence on alcohol who want to cut back on or eliminate alcohol use.
Medications for AUD, like acamprosate, can be as effective as medications regularly prescribed to treat common conditions such as hypertension. But before taking this or any medication, consider its side effects.
The most common side effect of acamprosate is diarrhea, which usually is mild and goes away after a few weeks. People with more severe and persistent diarrhea can take antidiarrheal medications to mitigate symptoms.
Before being prescribed acamprosate, patients — especially those age 65 and older — are typically screened for kidney impairment. People with severe kidney impairment should generally not take acamprosate. Those with mild to moderate kidney impairment should take lower doses.
Other, less common side effects include:
Patients using acamprosate who experience the rare side effect of suicidal ideation or who attempt suicide should stop using the medication and be regularly checked for signs of worsening depression.
Consult with a licensed health care provider before taking any medication, including acamprosate.
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Other considerations before taking acamprosate include the following:
It does not cause dependence. Acamprosate does not induce alcohol-related intoxication or cause dependence.
It does not interact with other drugs. Acamprosate is generally safe to use with other medications.
You should talk with your doctor if you are pregnant or breastfeeding. Consuming alcohol during pregnancy can harm fetuses. If you have AUD and are pregnant, may become pregnant, or are breastfeeding, talk to your medical provider about the relative benefits and risks of using acamprosate.
The cost may be covered by insurance or subsidized. Patients pay around $280 a month out of pocket for 180 tablets of acamprosate. The cost may be covered in part by public or private insurance. In some states, however, insurance coverage depends on prescribers obtaining prior permission from insurers. If you’re uninsured or underinsured, or you otherwise have trouble paying for treatment, ask an AUD treatment center near you if it offers financial assistance in the form of free or subsidized care.
If you are taking acamprosate, you may be wondering what you should do if you miss one of your three daily doses. If it’s near the time you were supposed to take it, take the missed dose. If it’s close to the time for the next dose, skip the missed dose and get back on schedule.
Content reviewed by Jasleen Salwan, M.D., MPH, FASAM, April 2023.