Acamprosate

Sujin Lee Weinstein, PharmD, BCPP

INDICATIONS

Brand name	Generic	Dose strength
Campral	Acamprosate	333 mg tablets (enteric coated, delayed release)

Traditional dosing: 666 mg three times a day
Alternative dosing: 999 mg twice-daily; may improve adherence (long half-life permits twice-daily dosing)

Initiate after alcohol withdrawal and the patient achieves a period of alcohol abstinence to improve tolerability
May be taken with or without food; however, taking with meals, three times a day, may enhance treatment adherence and reduce GI side effects
Should be continued, even if relapse occurs

Restores the imbalance of excitatory GABA and inhibitory glutamate neurotransmitters

Food reduces bioavailability; however, food may enhance treatment adherence and reduce GI side effects

Asthenia, anorexia, diarrhea, dizziness, flatulence, headache, insomnia, nausea, paresthesia, pruritis, sweating, vomiting
Gastrointestinal side effects are dose related and often decline with continued use.

Depression and suicidality – may occur with alcohol use, alcohol dependence and alcohol withdrawal

Age-related changes in metabolism and excretion may increase levels and effects.

Use with caution
Animal studies suggest teratogenicity.
Limited data in humans suggest low risk of teratogenicity.
Weigh benefits and risks of acamprosate treatment during pregnancy, including the risk of fetal alcohol syndrome associated with continued alcohol use

Use with caution
Inadequate information
Very poor maternal oral bioavailability (11%) – anticipate minimal systemic effects in infant

Parameter	Frequency	Rationale
Renal function	Treatment initiation Annually As clinically indicated	Adjust dose based on renal function
Changes in behavior or mood	Treatment initiation Annually As clinically indicated	Depression and suicidality

Since acamprosate is not metabolized by the liver, it is an appealing alternative for patients with hepatic impairment, e.g. patients with advanced alcohol use disorder.
Lacks the disulfiram-ethanol reaction when taken with alcohol and does not precipitate opioid withdrawal that may occur with disulfiram and naltrexone, respectively
Thrice-daily dosing is often an issue – dosing with meals or twice daily may improve adherence.
Not an ideal agent for patients with significant renal impairment (contraindicated for use in patients with Cr Cl < 30mL/min)

Acamprosate. In: Drugs and Lactation Database (LactMed®). Bethesda (MD): National Institute of Child Health and Human Development; September 19, 2022.
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Kelty E, Tran D, Lavin T, et al. Prevalence and safety of acamprosate use in pregnant alcohol-dependent women in New South Wales, Australia. Addiction. 2019;114(2):206-215. [PMID:30152012]
Kelty E, Terplan M, Greenland M, et al. Pharmacotherapies for the Treatment of Alcohol Use Disorders During Pregnancy: Time to Reconsider? Drugs. 2021;81(7):739-748. [PMID:33830479]
Quintrell E, Russell DJ, Rahmannia S, et al. The Safety of Alcohol Pharmacotherapies in Pregnancy: A Scoping Review of Human and Animal Research. CNS Drugs. 2025;39(1):23-37. [PMID:39388037]

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