Acamprosate

Basic acamprosate information

• INN (international nonproprietary name): Acamprosate
• Brand names available in the United Kingdom: Campral EC and generic acamprosate
• ATC code: N07BB03
• Forms and dosages: 333 mg gastro-resistant tablets
• Manufacturers in the United Kingdom: Merck Serono (Campral EC) and generic manufacturers
• Registration status in the United Kingdom: Prescription Only Medicine (POM)
• OTC / Rx classification: Prescription-only medicine (POM)

Everyday use and best practices

In the context of alcohol dependence treatment, acamprosate is commonly used to reduce cravings and support relapse prevention. Effectiveness can be influenced by how and when it is taken. Understanding the most suitable timing and dietary considerations can significantly improve adherence to treatment.

Morning vs evening dosing

Acamprosate is taken three times daily, usually morning, midday and evening, spaced through the day. Choose times that fit your daily routine so that doses are not missed.

Taking with or without meals

Acamprosate is usually taken with meals, which can help reduce gastrointestinal discomfort. Typical UK dietary habits, such as having main meals at regular times, can help in establishing a consistent dosing routine. Being aware of personal eating habits can assist patients in planning their medication intake effectively.

Safety priorities

When considering any medication, safety is paramount. Acamprosate is generally well-tolerated, but certain individuals should avoid it. Recognising contraindications and potential risks can guide decisions about using this medication responsibly.

Who should avoid it

Acamprosate must not be used in people with severe renal impairment (creatinine clearance below 30 mL/min). Furthermore, those with a history of hypersensitivity to acamprosate or its excipients, as well as individuals suffering from severe liver impairments, should also refrain from its use. It's essential to consult healthcare professionals for tailored advice.

Activities to limit

Patients starting acamprosate should assess their capability to drive or operate machinery. Although the medication isn’t typically associated with significant sedation or impairment, initial treatment phases may lead to dizziness or gastrointestinal side effects. Ensuring safety in daily activities is critical until the individual understands how acamprosate affects them personally.

Dosage and adjustments

When commencing treatment, the appropriate dosage of acamprosate is crucial for efficacy and safety. The NHS provides guidelines to help patients and healthcare providers make informed decisions about dosing.

General regimen

For adults, the standard dosage of acamprosate for people weighing over 60 kg is 666 mg (two 333 mg gastro-resistant tablets) three times a day, a total of 1998 mg daily. Lighter patients (under 60 kg) take a lower total daily dose, as directed by the prescriber. Treatment should start as soon as possible after alcohol withdrawal.

Special cases

In elderly patients or those with comorbidities, such as liver or renal impairments, dosage adjustments may be necessary. It is suggested that healthcare providers regularly monitor renal function and adjust the acamprosate dose accordingly, and a reduced dose (333 mg three times daily) is used in moderate renal impairment (creatinine clearance 30–50 mL/min).

What’s inside and how it works

Ingredients overview

Acamprosate contains the active ingredient acamprosate calcium, typically in a dosage of 333 mg per tablet. The tablets also contain inactive ingredients that give stability. The gastro-resistant coating allows the tablet to pass through the stomach and release acamprosate in the intestine, where it is absorbed.

Mechanism basics explained simply

Acamprosate works primarily by modulating neurotransmitter activity in the brain, particularly focusing on balancing the excitatory and inhibitory signals that are altered due to chronic alcohol consumption. By affecting the glutamate and gamma-aminobutyric acid (GABA) systems, acamprosate helps to reduce cravings for alcohol, promoting abstinence. This balancing act contributes significantly to a patient’s ability to maintain sobriety, making it a vital part of treatment for alcohol dependence. Simply put, it helps the brain readjust to functioning without alcohol, easing the transition to sobriety.

Main indications

Approved uses (MHRA listing)

The primary approved use of acamprosate by the MHRA is for the treatment of alcohol dependence. It is used to help people who have stopped drinking to maintain abstinence and reduce the risk of relapse, alongside psychological support.

Off-label uses in UK clinics

Acamprosate is not licensed for conditions other than alcohol dependence. Anyone considering use outside its licensed indication should consult their healthcare provider to weigh the risks and benefits carefully.

Interaction warnings

Food interactions (alcohol, tea/coffee)

When taking acamprosate, it is important to avoid alcohol, because the medicine is intended to support abstinence and works best in people who have stopped drinking. Tea and coffee are not known to interact with acamprosate. Discuss any specific dietary concerns with a healthcare provider.

Drug conflicts

Acamprosate has few drug interactions. However, caution is advised with medications that affect renal function, since acamprosate is eliminated unchanged via the kidneys. To ensure safety, it is vital for patients to disclose their complete medication lists, including over-the-counter drugs and supplements, to their healthcare provider before starting acamprosate.

Alternative choices

Several other medications are prescribed within the NHS for managing alcohol dependence. Among these, disulfiram and naltrexone are the main alternatives.

Disulfiram works by causing adverse reactions when alcohol is consumed, effectively deterring users from drinking. Naltrexone, on the other hand, blocks opioid receptors and reduces the rewarding effects of alcohol, thereby diminishing cravings.

• Pros of Acamprosate: Effective in reducing cravings, generally well-tolerated.
• Cons of Acamprosate: Requires adherence to a treatment schedule, may not work for everyone.

• Pros of Disulfiram: Strong deterrent against alcohol intake, suitable for highly motivated individuals.
• Cons of Disulfiram: Potential for severe side effects if alcohol is consumed, requires close monitoring.

• Pros of Naltrexone: Reduces craving and relapse rates, taken as a daily tablet.
• Cons of Naltrexone: May cause nausea, and requires a complete absence of opioids.

Regulation snapshot

The Medicines and Healthcare products Regulatory Agency (MHRA) has licensed acamprosate as a prescription-only medicine (POM) in the UK. It can only be supplied on prescription following an assessment of the patient's alcohol dependence. Acamprosate is available in the UK under the brand name Campral EC and as generics.

Frequently asked questions

1. Can I drink alcohol while taking acamprosate?
It’s advisable to avoid alcohol altogether while on acamprosate, as it works best when you are abstaining from drinking.

2. How long does it take for acamprosate to work?
Patients generally start noticing the benefits after about five to seven days of consistent use.

3. What are the common side effects of acamprosate?
The most reported side effects include gastrointestinal issues, such as diarrhoea, nausea, and abdominal pain.

4. How long should I take acamprosate?
Treatment usually lasts for up to one year, but this may vary based on individual circumstances and treatment progress.

Guidelines for proper use

When using acamprosate, it’s crucial to follow a few guidelines to optimise treatment effectiveness:

• Administration advice: Take acamprosate as prescribed, usually 666 mg three times a day after meals to reduce gastrointestinal discomfort.
• Monitoring: Regular follow-ups with a healthcare provider are essential to assess progress and adherence to the treatment plan.
• Patient support: Leverage available NHS resources, such as support groups and counselling services, which can complement the medication.
• Missed dose guidance: If a dose is missed, take it as soon as remembered, but skip it if the next dose is due; do not double up to make up for missed doses.

Support from healthcare professionals is invaluable in achieving and maintaining sobriety.

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