Adult: For the maintenance of abstinence in alcohol-dependent patients: <60 kg: 666 mg at breakfast, 333 mg at noon and 333 mg at night; ≥60 kg: 666 mg tid. Treatment should be initiated as soon as possible after the alcohol withdrawal period and maintained if the patient relapses. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines). Elderly: Not recommended. Treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
Renal Impairment
CrCl (mL/min)
Dosage
<30
Contraindicated.
30-50
Initially, 333 mg tid.
Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Administration
May be taken with or without food. Swallow whole & do not chew/crush/cut. Consult product literature for specific recommendations.
Contraindications
Severe renal impairment (CrCl <30 mL/min).
Special Precautions
Patient with suicidal ideation. Moderate renal impairment (CrCl 30-50 mL/min) and severe hepatic impairment (Child-Pugh class C). Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: CNS depression; suicidal thinking or behaviour. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain, flatulence. Reproductive system and breast disorders: Frigidity, impotence. Skin and subcutaneous tissue disorders: Pruritus, maculopapular rash.
This drug may cause CNS depression, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor renal function and weight. Assess for signs of suicidal ideation.
Overdosage
Symptoms: Diarrhoea. Management: Symptomatic and supportive treatment.
Drug Interactions
Increased plasma concentration with naltrexone.
Food Interaction
Decreased absorption with food.
Action
Description: Mechanism of Action: Acamprosate is a homotaurine analogue which interacts with glutamate and γ-aminobutyric acid (GABA) neurotransmitter systems in the CNS. It is believed to act by increasing the activity of the GABAergic system and decreasing the activity of glutamate within the CNS. Additionally, it restores the balance between GABA and glutamate activities which appear to be disrupted in alcohol use disorder. Pharmacokinetics: Absorption: Moderate, slow and sustained absorption from the gastrointestinal tract. Decreased absorption with food. Bioavailability: Approx 11%. Time to peak plasma concentration: 3-8 hours. Distribution: Crosses the blood-brain barrier. Volume of distribution: Approx 1 L/kg. Excretion: Via urine (as unchanged drug). Elimination half-life: 20-33 hours.
Chemical Structure
Acamprosate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 71158, Acamprosate. https://pubchem.ncbi.nlm.nih.gov/compound/Acamprosate. Accessed Feb. 26, 2024.
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