1. Section Editor(s): Risser, Nancy MN, RN, C, ANP
  2. Murphy, Mary CPNP, PhD, Literature Review Editors

Article Content

Acamprosate (campral) for alcoholism. The Medical Letter 2005;47(119):1-3.

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The drug acamprosate has a different method of action than the other two FDA-approved drugs for the treatment of alcohol dependence, naltrexone and disulfiram. Acamprosate reduces glutamatergic transmission and neuronal hyperexcitability during withdrawal from alcohol, reducing voluntary intake of alcohol in alcohol-dependent animals. In humans with alcohol dependence, trials that provided psychosocial support or behavioral treatment in addition to drug therapy reported abstinence rates between 18% to 61% compared to 4% to 45% in a placebo group. Trials that did not provide social support or did not require abstinence before starting the drug did not find any statistically significant benefit of acamprosate over placebo. In patients with normal renal function, two 333 mg enteric-coated tablets are prescribed three times daily with meals. Acamprosate is of similar cost ($100 monthly) and effectiveness as naltrexone. The cost of disulfiram is lower, about $22 monthly. The most common adverse effect of acamprosate is diarrhea, which is dose-related and transient. Suicidal ideas and attempts have occurred only rarely, but more often with the drug than with placebo. Acamprosate can be used in combination with naltrexone or disulfiram and should be used together with social support to gain its modest effectiveness.