What Is Acamprosate? How It Works for Alcohol Use Disorder?

If you’ve stopped drinking but still struggle with cravings, Acamprosate will help you stay sober. Used after detox, Acamprosate medication supports long-term recovery by balancing brain chemistry disrupted by alcohol. 

Acamprosate is especially effective when combined with therapy and structured support. In Florida, where over 1.3 million adults report binge drinking monthly, as reported in the 2015 National Survey on Drug Use and Health (NSDUH), relapse prevention is an integral part of alcohol addiction treatment. Acamprosate works by calming the overactive glutamate system and enhancing GABA activity, reducing post-acute withdrawal symptoms. 

Most people take Acamprosate as 666 mg three times a day. It’s usually well-tolerated, but some experience stomach issues, sleep trouble, or low mood. If it’s not the right fit, alternative medicines like Naltrexone or Disulfiram work better in alcohol addiction treatment.

What Is Acamprosate?

Acamprosate is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for treating alcohol use disorder (AUD). Sold under the brand name Campral, it is designed to help individuals maintain sobriety after they have stopped drinking. Acamprosate functions by stabilizing brain chemistry disrupted by prolonged alcohol use. It is prescribed as part of a comprehensive treatment plan, including therapy and counseling.

A 2004 meta-analysis of 17 clinical trials and multiple European studies, as cited in Patkar AA et al. 2013, in “Interventions for Addiction Chapter 56 – Medication for Cravings in Substance Use Disorders,” found that 36% of patients taking Acamprosate remained abstinent at six months, compared to 23% in the placebo group.

What Is the Chemical Composition of Acamprosate?

Acamprosate, chemically known as calcium acetylhomotaurinate, has the molecular formula C10H20CaN2O8S2. It consists of active and inactive ingredients. The active ingredient is acamprosate calcium, which helps restore neurochemical balance in the brain. Inactive ingredients in Acamprosate formulations include microcrystalline cellulose, croscarmellose sodium, magnesium stearate, and colloidal silicon dioxide, which assist in tablet formation and absorption. 

How Does Acamprosate Help in Alcohol Addiction Recovery?

Acamprosate helps in alcohol addiction recovery by reducing cravings and promoting neurochemical balance in the brain. Chronic alcohol use disrupts neurotransmitter activity, leading to hyperexcitability when alcohol is discontinued. This dysregulation contributes to persistent cravings and emotional distress, increasing the risk of relapse.

A 2004 meta-analysis by Mann K et al., titled “The Efficacy of Acamprosate in the Maintenance of Abstinence in Alcohol-Dependent Individuals: Results of a Meta-Analysis,” analyzed 17 high-quality RCTs with 4,087 individuals and found that 36.1% of Acamprosate-treated patients remained abstinent at six months, compared to 23.4% in the placebo group. 

What Is the Mechanism of Action of Acamprosate?

The mechanism of action of Acamprosate is modulating neurotransmitters in the central nervous system, particularly glutamate and gamma-aminobutyric acid (GABA), to reduce withdrawal symptoms and support long-term sobriety. Acamprosate helps restore this imbalance by reducing excessive glutamatergic activity while enhancing GABAergic transmission, thereby stabilizing brain function and reducing alcohol cravings.

A magnetic resonance spectroscopy (MRS) study by Umhau JC et al. (2010), titled “Effect of Acamprosate on Magnetic Resonance Spectroscopy Measures of Central Glutamate in Detoxified Alcohol-Dependent Individuals – A Randomized Controlled Experimental Medicine Study,” demonstrated that Acamprosate normalizes glutamate levels in the anterior cingulate cortex, a brain region associated with cravings and emotional regulation. 

How Long Does It Take for Acomprosate to Work?

It takes 5 to 8 days for Acamprosate’s consistent use to begin working, as it does not provide immediate relief, according to Drugs.com. Its full therapeutic effects, including reduced cravings and improved neurochemical balance, take several weeks to become noticeable. 

What Are the Approved Uses of Acamprosate in Florida?

The approved uses of Acamprosate in Florida include maintaining abstinence in individuals with alcohol use disorder (AUD) who have already stopped drinking. It is FDA-approved for relapse prevention but does not treat withdrawal symptoms or reduce alcohol consumption in those who are still actively drinking.

Are There Any Off-Label Uses of Acamprosate?

Yes, there are off-label uses of Acamprosate, including managing cocaine dependence, nicotine addiction, and psychiatric disorders like obsessive-compulsive disorder (OCD) and autism-related behaviors. 

According to Müller CA et al. 2011, in their study titled “Acamprosate and Its Potential Use in Drug Addiction Treatment: A Review,” Acamprosate reduces cocaine cravings and compulsive behaviors. Hollander E et al. 2005 found that Acamprosate helps reduce repetitive behaviors in autism spectrum disorder (ASD), though further studies are needed to confirm its efficacy in these conditions.

Does Insurance Cover Acamprosate Treatment in Florida? 

Yes, insurance mostly covers Acamprosate treatment in Florida if it’s part of a medically necessary alcohol use disorder treatment plan. Coverage depends on your provider, plan details, and whether the rehab center accepts your insurance. It is recommended that you always verify your insurance benefits.

Who Should Not Use Acamprosate?

Individuals with severe kidney disease (creatinine clearance ≤30 mL/min), pregnant or breastfeeding women, those who have not stopped drinking, and individuals with a known hypersensitivity to Acamprosate should avoid taking the medication. Since Acamprosate is eliminated through the kidneys, it poses a risk of drug accumulation and toxicity in patients with renal impairment. 

According to Drugs.com, pregnant and breastfeeding women must not take Acamprosate due to potential fetal harm observed in animal studies, though human data remains inconclusive. Individuals who are still consuming alcohol must not use Acamprosate, as it is designed to maintain abstinence, not initiate sobriety.

What Is the Recommended Dosage of Acamprosate?

The standard recommended dose of Acamprosate is 666 mg (two 333 mg tablets) taken three times daily, according to FDA guidelines. For individuals with moderate kidney impairment (creatinine clearance 30–50 mL/min), the dose must be reduced to 333 mg three times daily. It is taken orally, with or without food, and must be continued even if cravings subside, as long-term adherence enhances its effectiveness in supporting abstinence.

How Long Should You Take Acamprosate?

You should take Acamprosate for at least 6 months to a year, depending on your recovery progress, according to Hull University Teaching Hospital NHS Trust. Some patients continue taking it for over a year if they remain at risk for relapse. A 2015 study by the Canadian Agency for Drugs and Technologies in Health confirmed that Acamprosate remains safe and effective for long-term use, with sustained benefits in preventing relapse.

What Should You Do If You Miss a Dose of Acamprosate?

Take the missed dose as soon as you remember if you miss a dose of Acamprosate. However, if it is close to your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose, as this increases the overdose risk without improving effectiveness.

What Are the Side Effects of Acamprosate?

The side effects of Acamprosate include mood changes, appetite disturbances, neurological effects, and gastrointestinal issues. These side effects vary in severity and result from Acamprosate’s influence on neurotransmitter regulation and metabolic pathways. 

The side effects of Acamprosate are as follows:

Common Side Effects of Acamprosate

Common side effects of acamprosate include:

• Discouragement: Some individuals experience temporary feelings of hopelessness as their brain adjusts to the absence of alcohol’s dopamine effects.
• Sadness: Emotional distress is common in the early stages of treatment as the brain recalibrates from alcohol’s overstimulation of its pleasure centers.
• Irritability: Increased irritability and mood swings occur as the brain adapts to the lack of alcohol’s calming effects.
• Loss of appetite: Acamprosate’s modulation of glutamate receptors in the brain suppresses appetite by affecting the hypothalamus, which controls hunger.
• Fatigue or weakness: Some individuals feel weak or fatigued as their body adjusts to changes in neurotransmitter activity.
• Loss of interest: A temporary loss of interest in activities that were once enjoyable occurs as dopamine levels are restored to a more balanced state.
• Nervousness: Increased brain activity causes feelings of anxiety or restlessness, especially early on in treatment.
• Sleep disturbances: Difficulty falling or staying asleep is a reported side effect as Acamprosate impacts the neurotransmitters responsible for regulating sleep cycles.

Serious Side Effects of Acamprosate

Serious side effects of acamprosate include:

• Accidental injury: Dizziness and impaired coordination, particularly early in treatment, increase the risk of falls and other accidents.
• Bloating or fullness: Gastrointestinal discomfort, such as bloating, occurs as Acamprosate affects gut motility and digestive processes.
• Tingling or numbness: Temporary sensations of tingling, burning, or itching in the skin (known as “pins and needles”) result from changes in peripheral nerve signaling.
• Dizziness: Some individuals experience dizziness or lightheadedness, particularly during the initial stages of treatment, as the body adjusts to the medication.
• Dry mouth: Acamprosate reduces saliva production, leading to a dry mouth; in rare cases, mouth ulcers develop.
• Gas or flatulence: Increased gas production in the stomach or intestines occurs, causing discomfort in some patients.
• Itchy skin: Mild itching or skin irritation occurs as a mild hypersensitivity reaction to Acamprosate.
• Sweating: Excessive sweating, especially at night, occurs due to disruptions in the body’s temperature regulation as it adjusts to the treatment.

What Are the Alternatives to Acamprosate?

The alternatives to Acamprosate include Naltrexone, Disulfiram, and Nalmefene. These medications are used to treat alcohol addiction, each working through different mechanisms. 

The alternative medications to Acamprosate for alcohol addiction are as follows:

• Naltrexone
• Disulfiram
• Nalmefene

Naltrexone

Naltrexone blocks opioid receptors in the brain, reducing the release of endorphins triggered by alcohol. This lowers the pleasure associated with drinking and helps cut cravings. It’s especially effective for people who binge drink or experience strong urges. A 2010 Cochrane review by Rösner S et al., of 50 trials (7,793 patients) found Naltrexone reduced heavy drinking significantly and lowered overall alcohol intake.

Disulfiram

Disulfiram interferes with alcohol metabolism, causing nausea, vomiting, and headaches when alcohol is consumed. These unpleasant effects act as a deterrent. It’s most effective for those highly motivated to quit. However, a 2015 study by Crowley P. et al. 2015 noted that due to side effects and poor adherence, it’s less favored than Naltrexone or Acamprosate.

Nalmefene

Nalmefene blocks opioid receptors and reduces the rewarding effects of alcohol. It’s designed for people who drink heavily but aren’t physically dependent. When used with psychosocial support, it helps lower alcohol intake. The European Medicines Agency reported fewer heavy drinking days in patients using Nalmefene.

Can Acamprosate Cure Alcoholism?

No, Acamprosate cannot cure alcoholism. While it is an effective medication for helping individuals maintain abstinence and reduce cravings, it does not address the root causes of alcohol dependence or provide a cure. 

Recovery from alcoholism requires a comprehensive treatment plan that includes psychological support, counseling, and long-term commitment. 

Can Acamprosate Help with Alcohol Withdrawal Symptoms?

No, Acamprosate cannot help with alcohol withdrawal symptoms. Acamprosate is used after the detoxification process, primarily to help maintain abstinence and prevent relapse, rather than during the withdrawal phase.

How Effective Is Acamprosate in Treating Alcohol Addiction?

Acamprosate is highly effective in treating alcohol addiction, particularly in maintaining long-term abstinence. Clinical studies have demonstrated that it significantly improves abstinence rates, with a Cochrane review showing an 11% increase in alcohol-free days for individuals using Acamprosate alongside psychosocial treatment. It is considered a first-line treatment for alcohol addiction when combined with counseling.

How Does Acamprosate Differ from Other Alcohol Addiction Medications?

Acamprosate differs from other alcohol addiction medications in that it primarily works by restoring the balance of neurotransmitters in the brain, specifically by reducing glutamate activity and enhancing GABA transmission. Unlike medications like Naltrexone, which block the rewarding effects of alcohol, Acamprosate does not interfere with alcohol-induced pleasure but instead helps stabilize the brain’s neurochemical environment to reduce cravings and prevent relapse.