Acamprosate in the Treatment of Alcohol Use Disorder

Key Takeaways

• Acamprosate, known as Campral, is used to maintain abstinence from alcohol post-withdrawal and is thought to restore neurotransmitter balance in the brain.
• The drug is most effective when combined with counseling and is generally safe and well-tolerated.
• Acamprosate modulates neurotransmission. This aids in equilibrium between glutamate and GABA, which is crucial for reducing alcohol withdrawal distress.
• It is recommended as a first-line agent for AUD, particularly for those aiming to reduce alcohol intake or maintain abstinence.
• Clinical trials show acamprosate to be more efficacious than placebo in reducing relapse and increasing abstinence duration.
• Common side effects of acamprosate include gastrointestinal issues, with more serious concerns like suicidal thoughts requiring close monitoring.
• Acamprosate is often compared with other medications like naltrexone and disulfiram, with each having unique benefits and side effects.
• Future research in acamprosate aims to optimize its therapeutic potential and explore personalized medicine approaches for AUD treatment.

Acamprosate, known commercially as Campral, is a useful treatment for those with alcohol use disorder (AUD). It helps maintain abstinence from alcohol after withdrawal. Acamprosate works by restoring the balance of neurotransmitters in the brain that are disrupted by alcohol dependence. It is thought to influence NMDA receptors and CNS calcium channels and modulate glutamatergic and GABAergic neurotransmission. While the exact way it works is not fully understood, it has been found to be effective in treating AUD.

Acamprosate in Alcohol Use Disorder Management

Acamprosate is approved by the US Food and Drug Administration (FDA) for the treatment of alcohol use disorder (AUD). It works by affecting the N-methyl-D-aspartate (NMDA) receptor, which is involved in the chemical processes related to alcohol dependence and withdrawal. Studies show that acamprosate can help decrease the amount of heavy drinking and increase the number of abstinence days among those with AUD. This could potentially reduce the overall risks associated with the disorder.

The American Academy of Family Physicians (AAFP) and the American Psychiatric Association (APA) recommend acamprosate as a first-line agent, especially for individuals with moderate to severe AUD aiming to reduce alcohol intake or maintain abstinence. Patients who have not had success with non-drug treatments, or who have decided to try medication, may prefer pharmacotherapy. It is also suitable when there are no contraindications to its use.

Acamprosate’s Mechanism of Action

While acamprosate’s precise mechanism of action remains under investigation, current evidence suggests it plays a key role in restoring neurological balance. It is believed that acamprosate helps balance the neurotransmitters in the brain that control our mood. It does this by regulating the amount of two specific neurotransmitters, glutamate and gamma-aminobutyric acid (GABA), which can become imbalanced during alcohol withdrawal. This imbalance can cause distress, which can make it more difficult for people with alcohol use disorder (AUD) to recover. By aiding in this equilibrium, acamprosate can help reduce withdrawal symptoms and improve recovery outcomes.

Acamprosate works by affecting the brain’s GABA and glutamate systems, which are involved in alcohol dependence. Acamprosate is most effective when combined with counseling or other forms of support. Studies have shown that it can help people stay abstinent or reduce their alcohol use.

How Effective Is Acamprosate in Managing Alcohol Use Disorder?

Acamprosate has been tested in many clinical trials to see if it helps treat alcohol use disorder (AUD). Over 118 studies that compared acamprosate to a placebo found that acamprosate is better than a placebo at reducing the chance of relapse and increasing the amount of time people with alcohol dependence stay sober. Typically, these studies also included counseling or therapy along with acamprosate as part of a comprehensive approach to treating AUD.

As with any medication, the real-world impact of acamprosate depends on how it is implemented within treatment programs. Still, the evidence suggests that acamprosate, when used alongside psychosocial support, contributes positively to maintaining abstinence in alcohol-dependent patients, especially those who are abstinent at the initiation of treatment.

Side Effects of Acamprosate

Acamprosate can cause a range of side effects that patients and healthcare providers should be aware of. Common side effects reported can include:

• Sweating
• Dry mouth
• Itching
• Skin sensations like burning, crawling, numbness, tingling, prickling, etc.
• Weakness
• Dizziness
• Feelings of sadness
• Tiredness
• Anxiety
• Trouble sleeping
• Gas
• Upset stomach
• Diarrhea
• Nausea
• Loss of appetite

More serious side effects are less common but if you experience any of these symptoms, contact a medical professional immediately:

• Fear
• Severe feelings of emptiness or sadness
• Severe depression

Acamprosate vs. Other Medications in AUD Treatment

Acamprosate is recognized as a primary pharmacological treatment for alcohol use disorder (AUD), alongside naltrexone and disulfiram. Each medication has a distinct pharmacological profile and varying efficacy based on individual patient needs and responses. A systematic review and meta-analysis including 118 clinical trials indicated that both oral naltrexone and acamprosate significantly improved alcohol consumption-related outcomes compared with placebo.

While acamprosate is often a first-choice medication for AUD, it is essential to evaluate its efficacy and side effects in direct comparison with naltrexone and disulfiram, to optimize individual patient care and outcomes.

Acamprosate vs. Naltrexone in AUD Treatment

Acamprosate and naltrexone are both first-line pharmacological treatments for AUD, yet they differ in their mechanisms and efficacy. A meta-analysis suggests that while acamprosate may be more effective at maintaining abstinence, naltrexone could be preferable for reducing heavy drinking and cravings. 

Acamprosate, taken as a tablet thrice daily, is believed to modulate neurotransmitter systems to stabilize brain chemistry post-alcohol withdrawal. On the other hand, naltrexone, available as a tablet or an injectable, works by blocking opioid receptors to reduce the rewarding effects of alcohol. This lessens the urge to drink.

Relapse rates in studies, such as the one from a 2004 Randomized Controlled Trial (RCT), provide insight into the effectiveness of these medications when used alone or in combination. User ratings on platforms like Drugs.com also indicate slightly higher satisfaction with acamprosate compared to naltrexone. During the recovery process, it is important to closely monitor patients taking acamprosate due to its potential side effect of increased rates of suicidal thoughts.

Choosing between acamprosate and naltrexone for AUD treatment may depend on individual patient responses, specific treatment goals, and potential side effects. Both medications are deemed safe and effective. However, healthcare professionals should carefully consider the differences in their efficacy and side effects when developing a treatment plan.

Acamprosate vs. Disulfiram in AUD Treatment

Acamprosate and disulfiram are both used in the treatment of alcohol use disorder (AUD). However, they differ significantly in their approach, efficacy, and side effects. 

Acamprosate, with an average rating of 8.7 out of 10 from user reviews, is reported to have a positive effect in 84% of cases. As a first-choice medication, it is often preferred over disulfiram. When first-line treatments like acamprosate and naltrexone are ineffective, disulfiram is then considered. Disulfiram works by creating an acute sensitivity to ethanol. This leads to unpleasant effects when alcohol is consumed. 

Although not fully understood, Acamprosate’s mechanism is thought to modulate neurotransmission. It is believed that this process reduces withdrawal symptoms and the rewarding effects of alcohol consumption. Research indicates that acamprosate is effective in maintaining abstinence. 

Disulfiram’s use in AUD might be limited due to the strict abstinence required. The adverse reactions can make the drug challenging for some patients to adhere to. However, disulfiram’s efficacy can be enhanced with compliance ensured by family support.

Ultimately, a patient’s treatment plan should be tailored to their needs. Healthcare professionals should consider factors such as potential side effects, the likelihood of adherence, and the severity of AUD. Both medications have proven benefits but require more widespread utilization and understanding to maximize their therapeutic potential in AUD management.

Future Directions in Acamprosate Research for AUD Treatment

Research continues to explore how acamprosate can best be used to treat alcohol use disorder (AUD). Acamprosate has been shown to increase the likelihood of people staying sober for longer periods of time and has been tested in controlled studies. However, not everyone responds to acamprosate in the same way, so more personalized treatment needs to be researched.

Current research is focused on identifying metabolomics biomarkers. This step could help predict treatment responses and refine patient selection for acamprosate therapy. Studies are also evaluating the safety of acamprosate in patients with co-existing conditions like liver disease, a common comorbidity in AUD. This could lead to more inclusive treatment protocols.

Despite the promise of acamprosate, the relatively low adoption rates in clinical settings point to a need for improved dissemination and implementation strategies. Research needs to investigate the characteristics of organizations that affect the use of acamprosate in treatment for AUD. This will help ensure that more patients with AUD can benefit from the medication, leading to better outcomes and improved quality of life.

Medication-Assisted Treatment at The Recovery Village Columbus

Getting help for alcoholism at The Recovery Village Columbus can greatly improve the chances of overcoming alcohol addiction. The center’s team of professionals works closely with each patient to create and continuously adjust treatment plans that ensure long-term success. The Recovery Village Columbus offers several treatment options, including medical detox, inpatient rehab, and more to provide you with personalized care at our Joint Commission-accredited facility. Contact a Recovery Advocate today to take the first step toward living an alcohol-free life.