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Acamprosate for Alcohol Withdrawal

Alcohol addiction is commonly accompanied by certain imbalances in the chemicals in the brain, changed behaviors, and obtrusive thoughts that center around getting and drinking more alcohol. For people who are ready to end their addiction, alcohol withdrawal treatment is used to help them get sober and to prevent them from drinking alcohol in the future.

Successfully completing alcohol withdrawal through a professional detoxification program is a huge accomplishment, but it does not ensure sustained recovery. To boost the odds of long-term abstinence, many in the early stages of recovery will integrate the use of acamprosate to help restore normal brain function and prevent relapse.

What Is Acamprosate and How Does It Work?

Acamprosate is the generic name for a prescription medication recommended for people in recovery from alcohol dependence.1 Historically, the drug has also been marketed under the brand name Campral.2 The drug is administered as a round, white 333 mg tablet. The most commonly prescribed dose of acamprosate is 2 delayed-release tablets, to be taken orally 3 times per day for a total of about 2000 mg daily. 1

Alcohol abuse, dependence, and addiction create numerous changes to the brain and the way it operates. Acamprosate helps to reverse some of these changes and return more healthy, balanced functioning to the brain, potentially increasing a person's chance of maintaining abstinence and staying in recovery.3

Alcohol's Effects

Alcohol is carried through the bloodstream into the brain where it impacts certain key neurotransmitters in the brain.4 As steady use continues, the brain tries to adapt, producing some predictable results.4

First, the person will develop a level of tolerance, so they will need to drink more alcohol more regularly to produce the expected effect.4 Second, they may eventually become dependent, needing a steady supply of alcohol to keep the neurotransmitters in balance.4 Without alcohol, the new equilibrium is disturbed, and serious withdrawal symptoms, such as the following, may arise.4,5

  • Rapid pulse.
  • Sweating.
  • Insomnia.
  • Nausea.
  • Vomiting.
  • Anxiety.
  • Hallucinations.
  • Hand tremors.
  • Seizures.
  • Delirium tremens.

Alcohol Withdrawal

What withdrawal from alcohol feels like
While withdrawal will differ with each person, a typical timeline may look like this:5

  • Withdrawal begins only hours after the last drink.
  • Symptoms spike during day 2.
  • Symptoms improve after approximately 4-5 days.

For many, recovery remains a challenge long after this period of acute alcohol withdrawal passes.

Chronic alcohol use alters the brain in ways that can't be reversed over the course of a week.

When it is taken out of the equation, the brain has a chance to begin moving slowly back toward healthy functioning, but it can take months or years to find a new balance.During this slow transition, the recovering individual can experience protracted, or post-acute, withdrawal. This refers to symptoms that persist beyond the initial, expected withdrawal period. Potentially persisting symptoms might include:5,6

  • Anxiety.
  • Mood swings.
  • Irritability.
  • Hostility.
  • Bouts of:
    • Quicker breathing.
    • Increased pulse.
    • Intense sweating.
  • Insomnia.
  • Fatigue.
  • Problems thinking and concentrating. 

How Acamprosate Helps

Acamprosate does not prevent or lessen the effects of acute withdrawal. Rather, it is used to manage the effects of protracted withdrawal.3

The exact way that acamprosate works in the brain is unclear. Most likely, it works to return some balance to neurotransmitter systems affected by alcohol abuse.1 By doing so, it:3

  • Reduces the occurrence or severity of protracted withdrawal syndromes.
  • Alleviates alcohol cravings.

In this way, acamprosate helps lower relapse rates and extend the period of sobriety.1 

Acamprosate reaches its full effectiveness after you have been using it for between 5 and 8 days. Though the safety and efficacy of acamprosate therapy have only been evaluated for up to one year, the length of time that any given person remains on acamprosate therapy should be determined on a case-by-case basis, with input from treatment providers and the patient alike. 7

Who Can Use It?

Since acamprosate has a good safety profile, most people can use the drug without facing serious risks. The ideal candidate for acamprosate therapy is a person who has completed alcohol detox, is highly motivated to quit drinking completely, and is participating in treatment that incorporates psychosocial support.7

Other people who may benefit from acamprosate treatment include:

  • People who have a history of opioid dependence or addiction. Unlike other medications for alcohol dependence like naltrexone, acamprosate does not affect the opioid systems in the body. This makes the medication a great choice for people who:7
    • Receive opioid maintenance treatment with drugs like methadone or buprenorphine.
    • May use or relapse on opioids.
    • Use opioid medications for pain.
  • People with complicated medical histories who are on many medications. Drug interactions with acamprosate are very rare.7
  • People with liver conditions. Alcohol is known to create serious problems with the liver when used long-term. Acamprosate is not processed in the liver like other medications, so it won't place additional stress on this vital organ.7

Who Should NOT Use It?

Acamprosate treatment will not be appropriate for everyone.1 You should not take acamprosate if you:1,7

  • Have kidney problems. Since the drug is not processed in the liver, the kidneys work to excrete the substance, which may put extra strain on the organs.7
  • Are pregnant or breastfeeding. Studies show that animals administered the drug while pregnant were more likely to have still-born fetuses and babies with birth defects. It is not known whether acamprosate is transferred to the baby through the mother's breast milk.
  • Cannot use the medication consistently. Taking a medication 3 times daily can be a difficult regimen for some people. The medication is only effective when taken as prescribed, so only those committed to taking it should use it.
  • Are not an adult. Acamprosate has not been evaluated for safety in children or adolescents. 
Acamprosate Information at a Glance1,3
Medication Name, Costs Class of Medicine
  • Generic Name: Acamprosate
  • Generic Name Variations: N/A
  • Chemical Name: Calcium acetyl homotaurinate
  • Brand Name: Only generics available in U.S.
  • Brand Name Variations: N/A
  • Cost/Price: Varies
  • Used to Treat Addiction? Yes
  • Function or Use at Low Dose: Maintenance of abstinence from alcohol following detox
  • Function or Use at High Dose: N/A
  • Chemical Makeup: C10H20N2O8S2Ca
  • Duration of Action: 8 hours
Form, Intake and Dosage Interactions and Complications
  • Drug Forms: Delayed-release tablet
  • Administration Routes: Orally (swallowed)
  • Dosage: Two 333mg tabs 3 times daily
  • Overdose: Occurs rarely and at very high doses
  • Alcohol Interaction: N/A
  • Illicit Drugs: N/A
  • Prescription Medications: No significant drug interactions noted
Effects and Adverse Reactions Substance Abuse
  • Positive Effect: Treats symptoms of post-acute alcohol withdrawal
  • Adverse Reactions: Diarrhea, insomnia, anxiety, depression, headache, nausea, dizziness
  • Risk of Substance Abuse: Low
  • Signs of Abuse: N/A
Physiological Problem Signs and Symptoms Dependence and Addiction Issues
  • Withdrawal Syndrome: None noted
  • Tolerance: No tolerance noted
  • Cross Dependence: N/A
  • Physical Dependence: No dependence noted
  • Psychological Dependence: N/A
Legal Schedules and Ratings
  • Controlled Substances Act Rating: Unscheduled

Benefits and Risks

Across the U.S. and Europe, various studies have shown acamprosate is safe and effective, can improve abstinence rates, and extend the duration of recovery.7

The best acamprosate outcomes occur with a combination of the medication and behavioral therapy. After 6 months of treatment, 48% of those who utilized both acamprosate and therapy were still sober, while less than 38% of those who took an acamprosate/supportive counseling approach had remained sober at this point.8

Another strength of acamprosate is its minimal risk of overdose. Even at levels exceeding 20 times the normal daily dose, the drug does little to cause serious harm in the body.7

As mentioned, acamprosate has few side effects, the most common of which is mild diarrhea.7 Other less common side effects of acamprosate include:7

  • Stomach cramps.
  • Headache.
  • Changes in libido.
  • Insomnia.
  • Weakness.
  • Nausea.
  • Itchiness.
  • Dizziness.

In rare but serious situations, acamprosate can trigger anxiety and depression or worsen existing symptoms. 7 Depression is the most significant concern of the side effects because it can result in suicidal thoughts or suicide attempts. If you've had suicidal thoughts in the past, be open with your doctor. He or she may recommend another medication. Other options include naltrexone and disulfiram.8 As always, it is important to explore all of your medication options to find the choice best for you.

Myths about Acamprosate

Myth: You aren't sober if you use acamprosate.

Reality: This myth revolves around the common belief that people in recovery need to be completely free from all drugs, including medications, to truly be sober. Some see the use of drugs like methadone or acamprosate as just trading one addiction for another.2 However, this is not the case, and there are many paths to sobriety, some of which involve only therapy and some of which utilize medications.

Myth: Acamprosate is addictive.

Reality: Acamprosate has no potential for dependence or addiction.1 There is absolutely no evidence to suggest acamprosate is habit-forming at all, so you should feel comfortable trying acamprosate as a tool to aid your recovery.


Myth: Acamprosate is for alcohol withdrawal.

Reality: This myth is only partially true. Acamprosate is not for acute alcohol withdrawal that begins hours after last drink and lasts for about a week. It is for use during the extended, or post-acute, withdrawal period that last for many months after last use.3 For this reason, acamprosate is used long-term, after the acute symptoms subside.

Myth: It's dangerous to take acamprosate during acute withdrawal.

Reality: Acamprosate can be initiated during the acute alcohol withdrawal period.7 You do not have to wait until withdrawal symptoms subside to begin the medication, but acamprosate will not be effective for the symptoms you experience during this time.7

Treating Alcoholism

Alcoholism is a complicated condition but one that can be managed with effective, professional addiction treatment approaches.2 Most effective approaches begin with a period of detoxification, with the goal of safely and comfortably guiding the individual through the acute withdrawal process.2therapist writes notes on detox treatment for male patient
In cases of severe alcohol dependence, the acute withdrawal period is frequently managed within an inpatient detox setting that provides 24-hour monitoring, stabilization, and support from a team of physicians and other medical professions in hospitals or other detox centers.9 This level of care minimizes the risk of sometimes-dangerous complications that may arise during the acute withdrawal phase.

Following withdrawal, the detox program will refer the individual to a level of care appropriate for them, such as:2

  • Residential rehabilitation. Rehab for 30, 60, or 90 days is a good option for someone new to recovery. These programs allow the individual to escape the environment that fueled addiction while, at the same time, building needed coping skills with assistance from a clinical staff and fellow people in recovery. Some rehab programs, like therapeutic communities, may last for a year.
  • Outpatient treatments. These treatments allow the person to attend individual, group, and family therapy while continuing to live at home, work, and manage other responsibilities. Outpatient settings can vary from one hour per month to many hours each day to meet the individual’s treatment needs.

Alternatives to Medications for Alcohol Recovery

Acamprosate and other drugs used in medication-assisted treatments (MATs) can help with alcohol cravings, but they should not be the only course of treatment. Behavior therapies combined with medications provide the best chance of success. 2

There are a number of treatment methods available for psychological dependencies. Cognitive behavioral therapy models focus on modifying the thoughts and behaviors associated with the addiction. 2 Motivational interviewing helps to build internal motivation for recovery.2

People in recovery also benefit from practicing increased self-care and exploring other activities to help them cope with cravings and triggers. This may include meditation time, participating in art or music therapy, and engaging in activities with sober supports.

Questions and Answers (FAQ)

Can I begin using acamprosate when I quit alcohol? 

Yes. You can begin use of acamprosate immediately after you quit drinking, but your prescriber will likely wait about 5 days after your last drink to start the medication.7 You can use acamprosate throughout your recovery.

Are There any Home Remedies for Detoxing from Alcohol?

If you have been drinking chronically or in large amounts, trying to detox at home is a bad idea, and one that can potentially kill you. Without appropriate medical treatment, you put yourself at risk for extremely uncomfortable and possibly lethal withdrawal effects.9 Your health and well-being are of utmost importance. Always seek professional detox services to ensure safety, comfort, and the best foundation for long-lasting recovery.

Can I take acamprosate if I’m pregnant?

Acamprosate has not been deemed safe for use among pregnant woman. Studies have shown the medication can lead to birth abnormalities and stillbirth in animals. Acamprosate should only be prescribed to pregnant women when the potential benefits outweigh all the risks.1 

References

  1. U.S. National Library of Medicine: DailyMed. (2017). Acamprosate Calcium.
  2. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
  3.  Substance Abuse and Mental Health Services Administration. (2005). Acamprosate: A New Medication for Alcohol Use Disorders.
  4. Medscape. (2017). Withdrawal Syndromes.
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  6. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
  7. Substance Abuse and Mental Health Services Administration. (2009). Incorporating Alcohol Pharmacotherapies Into Medical Practice.
  8. Witkiewitz, K., Saville, K., & Hamreus, K. (2012). Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utilityTherapeutics and Clinical Risk Management8, 45–53.
  9.  Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
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