Acamprosate for Alcohol Use Disorder
Dr. Danish frequently works with patients using various medications, including Acamprosate, to manage Alcohol Use Disorder (AUD). Acamprosate is a medication specifically designed to help individuals with alcohol dependence maintain abstinence. Acamprosate has been called a “functional glutamate antagonist” because, like alcohol, it inhibits the glutamate system and enhances the GABA system. By stabilizing the levels of these neurotransmitters, and by increasing β-endorphins, Acamprosate helps reduce the brain's dependence on alcohol, thereby diminishing cravings and supporting long-term recovery.
Acamprosate's effectiveness in reducing alcohol cravings and consumption has been demonstrated in various studies. By targeting the neurochemical imbalances associated with alcohol dependence, this medication provides a valuable tool in the comprehensive treatment plans that Dr. Danish and his team at Philadelphia Integrative Psychiatry develop for their patients. This holistic approach, which combines medication management with therapy, lifestyle adjustments, and other supportive measures, aims to address the multifaceted nature of AUD and promote sustained recovery.
Benefits of Acamprosate
The research article titled Role of Acamprosate and Baclofen as Anti-craving Agents in Alcohol Use Disorder presents a 12-week study comparing the effectiveness of acamprosate and baclofen in reducing alcohol cravings among patients with Alcohol Use Disorder (AUD). The study involved 63 male patients who were alternately assigned to receive either acamprosate or baclofen after initial medical management of alcohol withdrawal symptoms. The study found that patients treated with acamprosate experienced significantly less severe cravings for alcohol and consumed fewer drinks on a single occasion compared to those treated with baclofen. Specifically, the mean Penn Alcohol Craving Scale (PACS) score was 7.10 for the acamprosate group versus 11.07 for the baclofen group, indicating a notable reduction in cravings. Additionally, the acamprosate group consumed an average of 5.45 drinks per occasion, compared to 8.82 drinks in the baclofen group.
Other studies have similar findings and benefits include:
Reduces Cravings: Studies have shown that Acamprosate significantly reduces cravings for alcohol, making it easier for individuals to maintain abstinence.
Decreases Alcohol Consumption: Patients treated with Acamprosate tend to consume fewer drinks on occasions when they do drink.
Improves Abstinence Rates: Acamprosate has been found to increase the number of days patients remain abstinent from alcohol.
Advantages Over Naltrexone
Acamprosate has a couple of advantages over naltrexone. Firstly, acamprosate is not metabolized by the liver and has not been associated with hepatotoxicity. For these reasons, acamprosate may be preferred over naltrexone in patients with significant liver disease. However, naltrexone is not absolutely contraindicated in persons with liver disease. Secondly, acamprosate can be started, if necessary, even before the person has fully stopped drinking. This is different from naltrexone, which should generally not be started in persons who are still drinking alcohol due to the potential for more side effects in those individuals.
Initiation and Monitoring
Acamprosate should be started as soon as the person stops drinking alcohol. Before starting, serum creatinine should be ordered, but typically, acamprosate is started without waiting for the results except in persons with a history of renal impairment.
How is Acamprosate Taken?
Acamprosate is available in only one strength—333 mg delayed-release tablets. The full dose is two tablets three times a day. There is no need to titrate the medication; it can be started directly at this dosage. To help patients remember to take the medication three times a day, it is suggested to pair it with mealtimes.
Dose Modifications
If the patient is unable to remember to take the medication three times a day, many experts give 999 mg twice a day (off-label). Some experts start at 999 mg twice a day for all patients.
If the person weighs less than 132 lbs, the dose should be reduced to two tablets twice daily.
In cases of moderate renal impairment (creatinine clearance 30 to 50 mL/min), the dose should be reduced to 333 mg (one tablet) three times a day. Acamprosate is not metabolized and is eliminated by the kidney as unchanged acamprosate or in the bile, so its levels are significantly affected by renal impairment.
Relapse Management
Acamprosate should be continued even if the patient relapses.
Caution and Dose Reduction
In patients with mild-to-moderate renal impairment, acamprosate can still be given, but the dose should be reduced, and renal function should be monitored closely.
In severe renal impairment, acamprosate should not be prescribed. Severe renal impairment is defined as either a creatinine clearance of less than 30 mL/min or an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m².
Side Effects of Acamprosate
Acamprosate is remarkably free of side effects. The side effects that occur at least twice as often as on placebo and in at least 1% of patients are minimal. Potential side effects of Acamprosate may include:
Diarrhea
Nausea
Vomiting
Stomach pain
Loss of appetite
Flatulence
Less common but more serious side effects can occur. Patients should discuss any side effects with their healthcare provider.
Who Should Not Take Acamprosate?
Acamprosate is not suitable for everyone. It should not be used by individuals with severe kidney impairment or those who are allergic to any of its components. Pregnant or breastfeeding women should consult their healthcare provider before starting Acamprosate.
For more on this topic and related subjects, check out these blogs:
Learn about the benefits of Naltrexone and Vivitrol in treating alcohol use disorder.
Discover how Disulfiram (Antabuse) can help stop drinking alcohol.
Find a variety of local and national outpatient and inpatient drug and alcohol treatment options tailored to individual needs.
Important Note
Dr. Danish creates these handouts based on research, but they are not meant to be 100% comprehensive. Patients are encouraged to discuss the ideas brought up in this document with their provider. For full lists of side effects on medications and supplements, visit drugs.com and webmd.com, as these lists are always expanding with more research occurring.
For more on this topic and related subjects, please look at these blogs:
Learn about the benefits of Naltrexone and Vivitrol in treating alcohol use disorder.
Discover how Disulfiram (Antabuse) can help stop drinking alcohol.
Find a variety of local and national outpatient and inpatient drug and alcohol treatment options tailored to individual needs.
LDN, or Low Dose Naltrexone, has some off-label evidence for alcohol use disorder.
Gabapentin is often used to help with anxiety, and there is growing evidence for its use in alcohol use disorder.
Sources
