Acamprosate for Alcoholism: How It Works, Side Effects, and Rehab Use

Why do people need clinical support to quit drinking? Can’t they just stop? Overcoming AUD is not a matter of a lack of willpower.

The Neurobiology of Alcohol Addiction

To begin with, some individuals are at elevated risk of developing AUD. Genetic, psychological, and social factors can predispose a person to abuse alcohol.

Prolonged alcohol consumption can also change a person’s brain, making it extremely difficult to stop drinking, even when people want to, due to alcohol’s effects on the brain regions responsible for self-control regulation.

After repeated exposure to alcohol, an individual’s neurotransmitters (chemicals the brain uses to function) can adapt to its presence. This results in an increased tolerance to alcohol (more is needed to feel its effects) and remodels a person’s brain chemistry (raising the central nervous system’s baseline activity to compensate for alcohol’s sedative effects).

These changes are the reason why stopping alone is difficult, and also, can be dangerous.

Brain chemistry changes can cause withdrawal symptoms if alcohol is suddenly stopped. These could be mild, but depending on the severity of the addiction, they can also put a person’s life at risk.

That’s why MAT is so valuable, as it can help normalize neurobiological changes caused by alcohol addiction.

The first stage of treatment for AUD is usually detoxification, a clinical process where specialists safely manage, with medication in some cases, the initial symptoms of alcohol cessation.

After detox, other medications, like acamprosate (a non-addictive support medication), are commonly prescribed to help a person remain sober.

So, what is acamprosate used for? Acamprosate is an FDA-approved medication used for treating AUD by minimizing alcohol cravings, reducing drinking risk, and helping individuals maintain sobriety.

Combined with counseling, support groups, and transparent professional guidance in rehab, acamprosate for alcoholism can help a person address the brain changes alcohol abuse produces.

What Is Acamprosate?

Acamprosate (Campral®) is an FDA-approved medication for alcohol addiction treatment.

Since 2005, it has been employed in the U.S. for AUD recovery in combination with behavioral therapies to maintain alcohol abstinence, as it can reduce the urge to resume alcohol consumption.

First developed in France in 1989, acamprosate calcium is a neurotransmitter analog that deters alcohol consumption in two ways: by reducing the intense cravings (desire) people feel to drink again after stopping, and by helping maintain abstinence from alcohol.

It’s especially beneficial, in combination with counseling and social support, for patients who have already detoxed, as it can normalize how the brain of a person who abuses alcohol works.

Prolonged alcohol abuse can modify a person’s brain chemistry, resulting in many consequences, including an elevated state of mental agitation. This is an imbalance that acamprosate is believed to restore.

Acamprosate may lessen the compulsive urge to drink that many individuals with AUD struggle with by reducing unpleasant abstinence symptoms that may trigger relapse, such as insomnia and mood disturbances.

It’s important to understand that first detoxing from alcohol while accessing emotional and social support is often key to success with acamprosate. It’s indicated for reducing cravings and maintaining abstinence, not for controlling alcohol withdrawal symptoms that are usually managed during detox.

The brand name Campral® has been discontinued in the United States, so currently, generic versions are available under prescription.

How Does Acamprosate Work?

How acamprosate works is by stabilizing brain chemistry disrupted by long-term alcohol abuse. Acamprosate’s MOA (mechanism of action) that promotes alcohol abstinence is not entirely understood.

As a medication whose structure resembles natural neurotransmitters, acamprosate directly acts on the central nervous system.

Normal brain functioning coordinates activity levels (for thinking, feeling, and moving, for instance) through chemicals (neurotransmitters) that increase or decrease cell activity.

Prolonged alcohol abuse disrupts the balance of these chemical processes.

Alcohol, a sedative, stimulates GABA (a calming neurotransmitter) while suppressing glutamate (an excitatory neurotransmitter).

When someone stops drinking, their brain, changed by chronic heavy drinking, may rebound in the opposite direction. They may experience decreased GABA activity and increased glutamate activity, which can cause agitation and persistent cravings even afteracute withdrawal symptoms have passed.

Acamprosate appears to modulate GABA and glutamate activity, helping to rebalance these systems. This may help reduce the lingering neurochemical overactivity after quitting alcohol, lowering the risk of relapse by easing cravings and improving abstinence rates.

According to research, acamprosate significantly increases the time people remain sober while reducing the risk of relapsing after detoxification.

Acamprosate’s effects don’t cause a high or sedation. Studies have found that individuals don’t develop a tolerance to acamprosate, abuse it, or experience withdrawal symptoms when ending treatment with it.

Acamprosate in Inpatient Alcohol Rehab: What to Expect

Acamprosate treatment is generally initiated in aninpatient rehab setting soon after a person has completed medically supervised alcohol detox.

When acamprosate is introduced depends on each person’s needs. How a person responds to it will be monitored by clinical staff to keep the patient safe and increase treatment success.

Your care team may evaluate how your kidneys function before using acamprosate for alcoholism, as it’s not safe for individuals with renal problems.

The typical dosage of acamprosate for AUD is two 333 mg tablets taken three times a day (6 tablets a day).

The effects of acamprosate on reducing cravings and promoting sobriety start to manifest about five to seven days after treatment initiation.

Acamprosate is usually a component of a comprehensive recovery program that may include attending counseling, joining support groups, and accessing social services.

Many studies have found it effective for both men and women, helping them remain abstinent and complete recovery programs at higher rates.

Treatment duration is highly personal, as each recovery journey depends on multiple unique circumstances, yet treatment with acamprosate usually lasts between six to 12 months.

It’s crucial to understand that professional supervision at every step of AUD treatment is fundamental to improving safety and success rates. For instance, if a person relapses or if cravings persist while on acamprosate, a clinician may reconsider its use and prescribe another medication. 

Acamprosate vs Other Alcohol Recovery Medications

Apart from acamprosate, there are in the U.S. two other FDA-approved medications for treating AUD. Here’s how they compare to acamprosate.

Acamprosate vs Naltrexone

Naltrexone is an acamprosate alternative for treating alcohol addiction. It can reduce the rewarding effects people seek when they drink (an intoxication state).

Both medications can reduce the cravings that may lead people to drink after quitting, though they do so through different neurochemical pathways.

Both medications are effective for treating AUD, but their use case differences depend on each patient’s unique needs.

Naltrexone may work better for:

• People who prefer monthly dosages, as naltrexone injections can be applied every four weeks. Acamprosate requires three daily doses, which can pose compliance challenges, especially for individuals with memory problems (a potential effect of AUD).
• Individuals with kidney disease, as acamprosate is contraindicated for them.
• People who are also battling an opioid use disorder, have detoxed from it and are not on any opioid agonist medication to manage it.

 Acamprosate can be better suited to:

• Individuals who are taking opioids for medical reasons or are receiving medication to treat opioid dependence, as acamprosate does not cause dangerous reactions like naltrexone can.
• People with liver disease (a common side effect of alcohol abuse), as it’s not metabolized by the liver like naltrexone.
• Individuals who cannot tolerate naltrexone’s side effects and interactions, as acamprosate has minor side effects and few drug interactions. 

Naltrexone blocks the same brain regions that opioids influence. So, it cannot be prescribed to opioid users.

Side effects of naltrexone include headache, dizziness, stomach pain, nausea and vomiting, and potential liver toxicity, so monitoring of liver enzymes is recommended. 

Acamprosate vs Disulfiram

Disulfiram was the first FDA-approved medication for treating alcoholism. When a person takes disulfiram, the medication modifies how their body breaks down (metabolizes) alcohol, making them more sensitive to it.

Even minor quantities of alcohol can produce a buildup of acetaldehyde (a toxic byproduct of alcohol metabolism), which can cause severe and unpleasant reactions like flushing, nausea, vomiting, sweating, low blood pressure, and palpitations.

Compared to acamprosate, which may stabilize brain chemistry disrupted by alcohol abuse and can reduce the desire to drink after quitting, disulfiram relies on a deterrent (dissuading) approach. The prospect of getting sick when drinking can be so powerful that it may be able to influence changing drinking habits and promote abstinence.

Acamprosate and disulfiram have best-fit scenarios for distinct individuals.

Acamprosate may work best for:

• People who have detoxed and wish to remain abstinent by addressing the neurobiological changes caused by alcohol abuse. It can also help people who only want to reduce alcohol intake, while disulfiram is only tailored to people who want to quit for good
• People with liver disease, seizure disorders, psychosis, and heart conditions, as disulfiram is not recommended for them due to potentially damaging adverse reactions
• Individuals with neurological challenges that may limit their understanding of the consequences of drinking while on disulfiram

Disulfiram’s properties are a best fit for:

• Highly motivated individuals who want to quit altogether and remain completely abstinent.
• Individuals with kidney conditions, as acamprosate may be dangerous for them.

Disulfiram’s common side effects tend to be minor and can include tiredness, mild drowsiness, rashes, and headaches. Due to its potential toxicity to the liver, people must be educated about the symptoms associated with it (like yellow skin and eyes, exhaustion, abdominal pain, and other signs) and their liver enzymes monitored by their care team.

Acamprosate Side Effects and Safety

Acamprosate has a very positive safety profile with very low overdose risk, mild side effects, and no significant drug interaction with other medications. There are no reports of abuse or tolerance with acamprosate and it does not produce a high or euphoric effect. No harmful effects have been reported when acamprosate is taken by someone who drinks.

Common acamprosate adverse effects include:

• Diarrhea (the most common side effect, usually transient)
• Flatulence
• Insomnia
• Weakness
• Anxiety
• Depression

Less common side effects are nausea, vomiting, headaches, dry mouth, stomach pain, dizziness, constipation, loss or increased appetite, nervousness, sweating, feeling angry or sad, and itching.

Serious adverse reactions to acamprosate are rare, so seek medical help if you are feeling confused, extremely sad, fearful, experience severe depression, want to harm yourself, have a metallic taste in your mouth, develop a rash, experience unusual sensations in your hands, arms, feet, and legs (numbness, burning, or tingling) or if other side effects don’t appear to improve or are severe.

Acamprosate is not recommended in patients with kidney function concerns as it can augment the risk of renal failure.

Notify your care team if you have struggled with suicidal thoughts before initiating treatment with acamprosate, as there may be an increased risk of suicide.

Rare allergic responses have been documented, so notify your care team if you have had any medication allergy response before or if you are allergic to sulfites. Also, discuss with your clinical team if you are pregnant, planning to conceive, or breastfeeding.

Tell your doctor if you have started drinking again after initiating acamprosate treatment.

Don’t discontinue acamprosate, even if you feel fine, without medical guidance, as your chances of relapsing may increase.

Acamprosate Interactions and Warnings

Severe acamprosate interactions with other medications have not been widely reported. It’s not metabolized by the liver, so interaction possibilities are limited.

However, as acamprosate may affect your capacity to drive or operate machinery, it’s best to fully disclose what medications you take to your medical team. Mention CNS depressants (benzodiazepines, sedatives, allergy medicines, and others), antidepressants, and any other medication, even natural supplements, to prevent potential interactions.

One of the main acamprosate warnings to remember is that it won’t reduce withdrawal symptoms after ceasing alcohol consumption. At that stage of your recovery journey, your care team will assist you in the detox phase before initiating acamprosate.

Treatment outcomes with acamprosate are positively associated with participating in comprehensive recovery programs that address the underlying reasons for alcohol abuse.

Acute renal failure is possible in individuals with kidney disease, so this risk should be evaluated before starting acamprosate treatment. Report to your physician if you are urinating less, have swelling, or feel extremely tired after taking acamprosate.

If you experience signs of allergic reactions, such as hives, breathing difficulties, and swelling, it is important to seek medical help.

Cost and Accessibility of Acamprosate

Acamprosate cost varies. As the Campral commercial brand is no longer available on the American market, generic availability is broad. There are many alternatives and prices available depending on where you live.

For a typical monthly dosage, you will need 180 tablets (two tablets, three times a day). Prices in retail pharmacies for cash-paying customers for 180 tablets range from 60 to 160 dollars. Generally, there are coupons available for accessing better prices.

Acamprosate is usually prescribed as part of a comprehensive recovery program for AUD, so its cost may be included in a rehab treatment.

If you have insurance, recovery programs can be fully or partly covered, depending on your benefits. It’s advisable to contact your health insurance provider to evaluate if you can access AUD treatment that is likely to include acamprosate if your care team considers it necessary.

Alcohol treatment centers across the United States offer grants, sliding scale financial assistance programs, other payment alternatives, and even free programs.

Don’t let money get in the way of seeking help.

Acamprosate FAQs

Supporting Sobriety Through Science and Compassion

Recovering from alcohol abuse disorder is possible.

Tools like acamprosate can help address brain changes caused by addiction and may promote recovery. However, acamprosate’s potential clinical benefits are not a standalone solution.

Alcohol addiction is fueled by multiple factors, like mental health conditions, trauma, adverse childhood experiences, and a person’s environment.

Addressing these underlying motives through counseling, support groups, and social assistance, while combining these interventions with medication like acamprosate, raises the possibility of starting a sober life. 

You deserve a fresh start. We encourage you to talk to an inpatient rehab that offers Acamprosate today. Speak about your desire to quit drinking and see if they are the right fit for your recovery goals. You can also use our online tool to find a treatment center near you.