Uses, benefits, and mechanism of action
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.
