If acamprosate is used in conjunction with therapy and other treatments, it can help people to maintain abstinence from alcohol.
Medication-Assisted Treatment for Alcohol Abuse
Campral (acamprosate) is one of only three medications that have been approved by the U.S. Food and Drug Administration (FDA) as a medication-assisted treatment (MAT) for alcohol use disorders. Along with ReVia (naltrexone) and Antabuse (disulfiram), acamprosate is backed by sufficient research to indicate that it does have a place in the treatment of alcohol abuse.
The FDA and all of the research discussing the use of acamprosate in the treatment of alcohol use disorders strongly acknowledge that the medication should be used as a part of an overall recovery program. It is not considered a standalone approach to treat alcohol use disorders.
How Does Acamprosate Work?
The full mechanism of action for acamprosate is not fully understood.
Research studies suggest that it affects NDMA, one of the major excitatory neurotransmitters in the brain, by inhibiting its function. It may also affect the primary inhibitory neurotransmitter in the brain, gamma-aminobutyric acid (GABA), by facilitating its functioning.
However, other mechanisms of action may also be associated with its use. For example, it may affect calcium channels in neurons.
Acamprosate is believed to reduce urges for drinking alcohol by dampening the effect of neuronal activity that leads to excitation, cravings, and urges.
Research on Campral
Research regarding the use of acamprosate for addressing alcohol abuse is mixed at best.
Some of the earliest research studies — all of which are randomized, double-blind, placebo-controlled studies — have traditionally been used to support its use.
However, larger scale studies, such as meta-analytic techniques, combine the results of studies that use similar methods to determine the effectiveness of different types of treatments for specific disorders. These studies are far more reliable than studies that are limited to using one group of participants, such as single sample research studies.
Meta-Analytic Research
There are several important studies using meta-analytic approaches that support the use of acamprosate.
In 2014, for instance, a large meta-analysis indicated that Campral was more effective than a placebo in helping individuals maintain abstinence from alcohol at periods ranging from 3 to 12 months.
Earlier in 2008, a meta-analysis compared Campral against the opioid antagonist naltrexone (ReVia). Findings indicated that acamprosate was significantly more effective than placebo in promoting abstinence.
However, it was not effective in reducing the rate of alcohol use in individuals who relapsed. ReVia was associated with increased abstinence and with less alcohol use in individuals who relapsed.
In 2013, a meta-analysis found that acamprosate use was associated with higher rates of abstinence in recovering individuals, but ReVia was associated with reduced alcohol consumption in individuals who continued to drink.
In 2015, the results of a study indicated that the use of acamprosate was significantly more likely to be associated with abstinence than no medication use.
Moreover, individuals using ReVia were more likely to experience side effects that resulted in them dropping out of the study than individuals using acamprosate.
Most Effective in Addressing Alcohol Use Disorders
The findings from the large body of research studies that have investigated the use of acamprosate in the treatment of alcohol use disorders have consistently listed several important points about using the drug.
While the drug may help individuals in their recovery from an alcohol use disorder, the medication is not designed as a standalone approach to address alcohol abuse. The findings from the research suggest the following:
- Acamprosate is intended to be used as a component or part of an overall treatment program that addresses alcohol abuse.
- Campral should not be used until a person has already established abstinence from alcohol. Individuals who are actively drinking will not receive the full benefit of the medication.
- The motivation of the individual to address their alcohol abuse is a key factor that influences the outcome and efficacy of the medication. People in treatment who are not motivated to become abstinent from alcohol typically do not receive the benefits of the medication.
- Campral does not:
- Reduce alcohol intake in people actively drinking alcohol
- Reduce the effects of alcohol use
- Produce abstinence in individuals who are actively drinking
- Address withdrawal symptoms associated with discontinuing alcohol
What to Expect
People who have been abstinent from alcohol for five days or longer should expect that acamprosate will help them control their urges for alcohol.
At the same time, however, the person should be actively involved in a comprehensive treatment program for their alcohol use disorder and should be following the program recommendations.
Acamprosate will not lead to increased motivation unless the individual is already self-motivated to stop drinking.
Are There Any Adverse Effects?
Acamprosate has relatively few side effects in most of the people who use it, but all drugs carry the potential for some side effects.
The side effects associated with acamprosate appear to be relatively rare. The most common side effects individuals report includes:
- Gastrointestinal problems, such as nausea and flatulence
- Loss of appetite
- Dry mouth, dizziness, muscle aches, and insomnia
- Increased sweating and/or itching
- Feeling jittery or mildly anxious
- Depression or, in rare cases, psychotic behaviors
Most of the side effects that occur will typically resolve over time. Individuals who reported side effects to their physician were addressed successfully in most cases.
Individuals who experience allergic reactions, such as swelling of the lips, swelling in the extremities, rash, hives, tremors, anxiety, and confusion, should stop taking the medication and contact their physician immediately.
Other Applications
Research studies have investigated the effectiveness of acamprosate in the treatment of other types of substance use disorders, including opioid use disorders and stimulant use disorders.
At the current time, there is not enough research to determine if the drug should be approved for use in these instances. However, it may be used off-label to assist in the treatment of other substance abuse issues.
How Is Acamprosate Most Effectively Used?
Acamprosate is most effectively used when the person is involved in a comprehensive substance use disorder treatment program for alcohol abuse. This means that the individual is actively participating in therapy, peer support groups like Alcoholics Anonymous, treatment for any co-occurring conditions, and other needed interventions.
The drug is not effective when the individual is not actively involved in a formal program of recovery for their alcohol abuse.
Acamprosate is a prescription medication. This means that the drug is not safe to use unless the person is under the supervision of a physician who can monitor them as they use the drug.
The drug should not be used by individuals unless it is prescribed to them, and people should never attempt to use any prescription medication on their own. People who have regularly abused alcohol should seek professional help if they decide to stop drinking.
There is the potential to develop life-threatening seizures during withdrawal from alcohol. Medical professionals can help them stay safe during the withdrawal period.
