Acamprosate
CAMPRAL
What it isGlutamatergic modulator; maintenance of abstinence in alcohol use disorder.
Why this oneIt has no hepatic metabolism, so it is usable in liver disease where naltrexone is not.
What limits itThree-times-daily dosing with a large tablet burden. Renally cleared; it does not reduce craving in active drinking.
FDA-approved for
- alcohol use disorder (2004)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Maintenance of abstinence in alcohol dependence (abstinent at initiation) | adult | 666 mg TID | 666 mg TID | 666 mg TID |
Renal Moderate (CrCl 30–50 mL/min): 333 mg TID; severe (CrCl ≤30 mL/min): contraindicated.
Hepatic Undefined
Instructions
- Initiate as soon as possible after alcohol withdrawal once abstinence is achieved; continue even if the patient relapses.
- Use as part of a comprehensive psychosocial treatment program.
- May be taken with or without food (dosing with meals may aid adherence).
- Swallow delayed-release tablets whole.
- Monitor for emergence of depression or suicidal ideation.
Contraindications
- Severe renal impairment (CrCl ≤30 mL/min)
Cautions
- Dose reduction required in moderate renal impairment
- Suicidality and depression — monitor patients and alert families/caregivers
- Does not eliminate or diminish alcohol withdrawal symptoms
Adverse reactions
- diarrhea, flatulence, nausea, anorexia, asthenia, pain, accidental injury, anxiety, depression, dizziness, dry mouth, insomnia, paresthesia, pruritus, sweating
Pregnancy Teratogenic in animals; use during pregnancy only if potential benefit justifies the potential fetal risk.
Lactation Unknown whether excreted in human milk (present in rat milk); exercise caution in nursing women.
NO BOXED WARNINGS
Principal riskThree-times-daily dosing; renally cleared
Cost, est. cash$10–$300/month
Generic entry2013
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Acamprosate ballicule
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Memory aids: mascots and interaction avatars
for alcohol use disorder
standard dose is 666 mg T.I.D.
