Acamprosate: Definition, Mechanism of Action, Uses, Dosage, Side Effects, Alternatives

Acamprosate helps individuals maintain abstinence from alcohol and drugs after detoxification. From 2000–2023, more than 41,500 North Carolinians lost their lives to a drug overdose. In 2023 alone, 12 North Carolinians died from a drug overdose each day according to the NCDHHS Division of Public Health. This highlights the urgent need for North Carolinians to receive medications like acamprosate, which supports long-term recovery by helping individuals maintain abstinence from alcohol following detox.

Acamprosate works by stabilizing neurotransmitter activity, specifically by reducing excessive glutamate and enhancing GABA function. 

The approved uses of Acamprosate include maintaining abstinence in individuals with alcohol dependence and reducing relapse risk. 

The standard dosage of Acamprosate is 666 mg (two 333 mg tablets) taken three times daily, with adjustments required for patients with kidney impairment. 

Mild side effects of Acamprosate include diarrhea, nausea, and insomnia, while severe side effects like depression and allergic reactions are rare. 

Alternatives to Acamprosate for AUD treatment include Naltrexone, which blocks alcohol’s rewarding effects, and Disulfiram, which creates an aversive reaction to alcohol consumption. 

What Is Acamprosate?

Acamprosate is an FDA-approved prescription medication used to support abstinence in individuals recovering from alcohol use disorder (AUD). Marketed under the brand name Campral, it was approved by the U.S. Food and Drug Administration (FDA) in 2004 for the maintenance of alcohol abstinence following detoxification. 

Acamprosate does not prevent withdrawal symptoms but helps reduce cravings and the likelihood of relapse.

According to the 2022–2023 National Survey on Drug Use and Health (NSDUH), approximately 9.61% of North Carolinians aged 12 and older—equating to about 872,000 individuals—were estimated to have Alcohol Use Disorder (AUD). Despite this significant prevalence, only 4.02% of people in the state received any form of substance use treatment during that period. Despite acamprosate’s effectiveness, acamprosate is underutilized, with prescription rates significantly lower than naltrexone and disulfiram.

How Does Acamprosate Help in Alcohol Addiction Recovery?

Acamprosate helps in alcohol addiction recovery by reducing cravings and restoring neurochemical balance in the brain. Chronic alcohol use disrupts neurotransmitter systems, particularly glutamate and gamma-aminobutyric acid (GABA), leading to excessive excitability and withdrawal-related distress. 

Acamprosate modulates glutamate activity and enhances GABA function, reducing hyperexcitability and stabilizing brain function during abstinence. According to a study by Karl Mann titled “The Efficacy of Acamprosate in the Maintenance of Abstinence in Alcohol-Dependent Individuals,” published in Alcoholism: Clinical and Experimental Research (2004), acamprosate increased continuous abstinence rates to 36.1% compared to 23.4% with placebo. 

How Does Acamprosate Work?

Acamprosate works by regulating neurotransmitters in the central nervous system, specifically balancing glutamate and GABA activity. Chronic alcohol consumption disrupts this balance, causing excessive glutamate activity and reduced GABA function, which leads to withdrawal symptoms and heightened cravings. 

Acamprosate acts as a functional glutamate antagonist, reducing excitatory neurotransmission while enhancing GABA’s inhibitory effects. This stabilization helps prevent the hyperexcitability that contributes to relapse.

Acamprosate reduces alcohol withdrawal-related neurochemical imbalances and decreases excitatory signaling, leading to improved abstinence rates. By modulating neurotransmitters, acamprosate helps individuals recover from alcohol dependence with fewer withdrawal-related disturbances.

Why Does Acamprosate Require a Full Detox Before Starting Treatment?

Acamprosate requires a full detox before starting treatment because it is only effective in maintaining abstinence, not in managing withdrawal symptoms. Unlike benzodiazepines or other withdrawal medications, acamprosate does not alleviate acute alcohol withdrawal but works by stabilizing brain chemistry after the withdrawal phase is complete. 

If alcohol remains in the system, the drug cannot effectively regulate neurotransmitter activity, reducing its therapeutic benefit. Acamprosate shows a significant increase in abstinence rates only in patients who had already completed detoxification. 

How Long Does It Take for Acamprosate to Work?

It takes approximately 5 to 7 days for acamprosate to start working, with full effects developing over several weeks of continuous use. Unlike medications that provide immediate symptom relief, acamprosate gradually stabilizes neurotransmitter function, reducing alcohol cravings over time. 

Most patients experience a noticeable reduction in cravings after two to four weeks of consistent use, though individual responses vary. According to a study by Karl Mann titled “The Efficacy of Acamprosate in the Maintenance of Abstinence in Alcohol-Dependent Individuals,” published in Alcoholism: Clinical and Experimental Research (2004), acamprosate-treated patients showed improved abstinence rates within the first month, with maximum benefits observed after 90 days. 

For optimal results, acamprosate is added as part of a comprehensive recovery plan, including therapy and behavioral support. 

What Are the Approved Uses of Acamprosate?

The approved uses of acamprosate are the maintenance of abstinence and relapse prevention in individuals recovering from alcohol use disorder (AUD). The FDA-approved indication for acamprosate is to support long-term sobriety in individuals who have already completed detoxification. 

It does not treat withdrawal symptoms or reduce alcohol’s intoxicating effects, but it helps stabilize brain chemistry to lower the risk of relapse.

While primarily used for AUD, ongoing studies are evaluating its potential for other neurochemical disorders, though these are not FDA-approved applications.

Who Can Benefit from Taking Acamprosate?

Individuals with severe alcohol use disorder (AUD), multiple relapses, and a strong commitment to abstinence can benefit from taking acamprosate. It is most effective for patients who have completed detox and need support in maintaining long-term sobriety. 

A 2013 randomized controlled trial conducted partly in North Carolina found acamprosate’s effectiveness varied based on patients’ treatment goals, with better outcomes in those aiming for abstinence rather than reduction of drinking according to “Efficacy of acamprosate for alcohol dependence in a family medicine setting in the United States: a randomized, double-blind, placebo-controlled study” published by Alcohol: Clinical and Experimental Research.

Patients with liver disease also benefit, as acamprosate is not metabolized by the liver, making it safer than other AUD medications.

Who Should Avoid Taking Acamprosate?

Individuals with severe kidney disease, pregnant women, and those still consuming alcohol should avoid taking acamprosate. Patients with severe kidney impairment should not use acamprosate because it is eliminated through the kidneys, and reduced kidney function increases the risk of drug accumulation and toxicity. 

Pregnant women should avoid acamprosate due to limited safety data and potential fetal risks, as studies on teratogenic effects remain inconclusive. People who are still drinking alcohol should not take acamprosate because it is only effective in maintaining abstinence, not in reducing withdrawal symptoms or counteracting alcohol’s effects.

What Is the Recommended Dosage of Acamprosate?

The standard recommended dose of Acamprosate is 666 mg (two 333 mg tablets) taken three times daily. This dosage is based on clinical trials demonstrating its effectiveness in maintaining abstinence in individuals recovering from alcohol use disorder (AUD). 

For patients with moderate kidney impairment (creatinine clearance between 30–50 mL/min), the dose is reduced to 333 mg three times daily. Acamprosate is not recommended for individuals with severe renal impairment (creatinine clearance below 30 mL/min) due to poor drug elimination.

What Should You Do If You Miss a Dose of Acamprosate?

You should take the missed dose of Acamprosate as soon as you remember, but skip it if your next scheduled dose is near to avoid an overdose risk if you miss a dose. Doubling doses leads to adverse effects without improving treatment outcomes. 

How Long Should You Take Acamprosate?

You should take acamprosate for at least six months to a year, with longer use recommended for those at high risk of relapse. 

What Are the Side Effects of Acamprosate?

The side effects of Acamprosate are diarrhea, nausea, and insomnia, with gastrointestinal issues being the most common. 

Mild Side Effects of acamprosate include:

• Diarrhea: It is the most common side effect, occurring in up to 17% of patients, according to a study by Karl Mann published in Alcoholism: Clinical and Experimental Research (2004). Diarrhea occurs because Acamprosate alters electrolyte balance in the intestines, leading to increased water secretion. Patients are advised to stay hydrated and consult a doctor if symptoms persist.
• Nausea: Nausea results from Acamprosate’s interaction with the gastrointestinal tract. It is usually mild and improves with continued use or by taking the medication with food. In most cases, dose adjustments are not required.
• Insomnia: Insomnia occurs due to Acamprosate’s effects on neurotransmitter balance. Alcohol-dependent individuals often have disrupted sleep patterns, which Acamprosate helps regulate over time. Sleep disturbances usually improve after a few weeks of continued treatment.

Severe Side Effects of acamprosate include:

• Depression and Suicidal Thoughts: While rare, some patients experience increased depression or suicidal ideation, particularly those with a history of mood disorders. According to the U.S. Food and Drug Administration (FDA), patients taking Acamprosate should be monitored for mood changes, especially in the first few months. Immediate medical attention is required if severe depressive symptoms arise.
• Allergic Reactions: Severe allergic reactions, including rash, itching, or swelling, are uncommon but require immediate discontinuation and medical evaluation. 
• Kidney-Related Issues: Since Acamprosate is eliminated through the kidneys, patients with pre-existing kidney disease experience worsening renal function. Dose adjustments are necessary for those with moderate kidney impairment. The drug is not recommended for individuals with severe renal dysfunction (creatinine clearance <30 mL/min).

What Are the Alternatives to Acamprosate for Alcohol Addiction Treatment?

The alternatives to Acamprosate for alcohol addiction treatment are Naltrexone, Disulfiram, and behavioral therapy. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Naltrexone reduces cravings by blocking opioid receptors, Disulfiram discourages drinking by causing unpleasant reactions to alcohol, and therapy enhances long-term recovery by addressing behavioral triggers.

The alternatives to acamprosate for alcohol addiction treatment are explained below:

• Naltrexone: Naltrexone is an opioid receptor antagonist that reduces alcohol cravings by blocking the brain’s reward response to alcohol consumption. Unlike Acamprosate, Naltrexone helps control cravings even if alcohol is still in the system, making it suitable for individuals who struggle with cutting down before quitting entirely. 
• Disulfiram: Disulfiram works by blocking the enzyme aldehyde dehydrogenase, causing a toxic buildup of acetaldehyde when alcohol is consumed. This leads to severe nausea, flushing, and palpitations, acting as a deterrent to drinking. Unlike Acamprosate and Naltrexone, Disulfiram does not reduce cravings but discourages alcohol use through an immediate physical reaction.  Disulfiram requires strong commitment, as drinking even small amounts of alcohol causes dangerous reactions. It is most effective in highly motivated individuals or those under supervised treatment programs.

Is Acamprosate Used During Addiction Treatment in Charlotte, North Carolina?

Yes, acamprosate is utilized in alcohol addiction treatment programs in Charlotte, North Carolina. It is commonly incorporated into medication-assisted treatment (MAT) plans to help individuals maintain abstinence by reducing cravings and stabilizing brain chemistry disrupted by chronic alcohol use. Addiction Treatment centers in Charlotte integrate acamprosate alongside counseling and behavioral therapies to support long-term recovery.

What Happens if You Drink Alcohol While Taking Acamprosate?

Low effectiveness, increases in relapse risk, and neurochemical balance disruption happen if you drink alcohol while taking Acamprosate. Unlike Disulfiram, Acamprosate does not cause an immediate physical reaction to alcohol, but it loses its ability to support abstinence if alcohol is reintroduced. 

According to a study by Mason et al., published in Neuropsychopharmacology (2006), patients who drank while on Acamprosate had relapse rates 45% higher than those who remained abstinent. Acamprosate works best when taken as part of a structured recovery plan that includes complete sobriety and behavioral therapy.

What Is the Success Rate of Acamprosate in Preventing Alcohol Relapse?

The success rate of Acamprosate in preventing alcohol relapse is approximately 36–50%, with higher abstinence rates when combined with therapy. According to relapse rates for alcohol use disorder in North Carolina are estimated to be between 40% and 60%, which is consistent with national averages. This means that 4 to 6 out of every 10 people who receive treatment for alcohol addiction in North Carolina are likely to experience a relapse at some point during their recovery according to SAMHSA.

Is Acamprosate Covered by Insurance in North Carolina?

No, Acamprosate is a prescription medication and is not available over the counter. It requires a doctor’s prescription because its use must be monitored for effectiveness, adherence, and potential side effects. 

According to the U.S. Food and Drug Administration (FDA), Acamprosate is regulated to ensure proper medical supervision in alcohol use disorder (AUD) treatment. Patients seeking Acamprosate must consult a healthcare provider to determine if it is appropriate for their recovery plan.