Introduction
Campral (acamprosate calcium) is a synthetic drug approved by the FDA for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation. It is typically used as part of a comprehensive management program that includes psychosocial support. Unlike other medications used in alcohol dependence treatment, Campral does not cause disulfiram-like reactions when alcohol is consumed.
Mechanism of Action
Campral's exact mechanism of action is not fully understood, but it is believed to interact with glutamate and gamma-aminobutyric acid (GABA) neurotransmitter systems. Acamprosate is structurally similar to the amino acid neurotransmitter taurine and appears to restore the balance between neuronal excitation and inhibition that is disrupted in chronic alcohol use. It modulates glutamatergic neurotransmission by acting as a partial agonist at NMDA receptors and may reduce glutamate hyperactivity during alcohol withdrawal, thereby decreasing alcohol craving.
Indications
- Maintenance of abstinence from alcohol in alcohol-dependent patients
- Used as part of a comprehensive treatment program that includes psychosocial support
- Most effective when initiated as soon as possible after abstinence is achieved
Dosage and Administration
Standard dosing:- 666 mg (two 333 mg tablets) three times daily
- Can be taken with or without food
- Mild renal impairment (CrCl 30-50 mL/min): 333 mg three times daily
- Moderate to severe renal impairment (CrCl <30 mL/min): Contraindicated
- Hepatic impairment: No dosage adjustment required
- Elderly: Use with caution due to potential renal function decline
- Pediatrics: Safety and effectiveness not established
Pharmacokinetics
Absorption: Poorly absorbed orally with bioavailability of approximately 11% Distribution: Distributed extracellularly with minimal protein binding Metabolism: Not metabolized hepatically Elimination: Excreted unchanged primarily via kidneys with elimination half-life of 20-33 hours Steady-state: Reached within 5 days of dosingContraindications
- Severe renal impairment (creatinine clearance ≤30 mL/min)
- Known hypersensitivity to acamprosate calcium or any component of the formulation
Warnings and Precautions
- Suicidal ideation: Monitor for emergence or worsening of depression, suicidal thoughts or behavior
- Renal impairment: Use contraindicated in severe renal impairment; reduce dose in moderate impairment
- Alcohol withdrawal: Not indicated for treatment of alcohol withdrawal symptoms
- Pregnancy: Use during pregnancy only if potential benefit justifies potential risk (Pregnancy Category C)
- Lactation: Not recommended during breastfeeding
Drug Interactions
- No significant pharmacokinetic interactions have been identified due to lack of hepatic metabolism
- No interactions with disulfiram, naltrexone, antidepressants, or anxiolytics
- Theoretical interactions with other NMDA antagonists (e.g., memantine, ketamine) may occur
Adverse Effects
Common (≥5% and more frequent than placebo):- Diarrhea (16%)
- Nausea, vomiting, abdominal pain
- Flatulence, pruritus
- Headache, anxiety, depression
- Insomnia, asthenia
- Suicidal ideation and behavior
- Severe depression
- Acute renal failure (in patients with pre-existing renal impairment)
Monitoring Parameters
- Renal function: Baseline and periodic assessment of creatinine clearance
- Mental status: Regular assessment for depression and suicidal ideation
- Treatment adherence: Monitor compliance with medication and psychosocial program
- Alcohol abstinence: Regular assessment of drinking behavior
- Adverse effects: Monitor for gastrointestinal symptoms and other side effects
Patient Education
- Take medication exactly as prescribed, even if feeling well
- Continue participation in counseling and support programs
- Do not stop taking Campral without consulting your healthcare provider
- Report any thoughts of suicide or worsening depression immediately
- Inform healthcare providers about all medications being taken
- Understand that Campral will not cause unpleasant effects if alcohol is consumed
- Store at room temperature away from moisture and heat
References
1. Mason BJ, Heyser CJ. Acamprosate: A prototypic neuromodulator in the treatment of alcohol dependence. CNS Neurol Disord Drug Targets. 2010;9(1):23-32. 2. FDA Prescribing Information: Campral (acamprosate calcium) Delayed-Release Tablets. 3. Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889-1900. 4. Kranzler HR, Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: A review. JAMA. 2018;320(8):815-824. 5. Mason BJ. Acamprosate in the treatment of alcohol dependence. Expert Opin Pharmacother. 2005;6(12):2103-2115. 6. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. JAMA. 1997;278(2):144-151.
This information is provided for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for personalized medical guidance.