How Does Acamprosate Reduce Alcohol Cravings?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) estimate that 29.5 million people in the United States have alcohol use disorder (AUD). AUD is a pattern of excessive drinking in which a person has trouble controlling their alcohol intake, is preoccupied with drinking, and continues drinking even when it causes health issues and other problems.

Certain medications can be used, along with counseling and social support, to help people with alcohol use disorders who have quit drinking to stay sober. One such commonly prescribed prescription medication that helps with alcohol abstinence is acamprosate. Please continue reading to learn more about how acamprosate helps to treat alcohol dependence.

What is used to suppress alcohol cravings?

The following medications approved by the United States Food and Drug Administration (FDA) are used to suppress alcohol cravings and treat alcoholism:

Acamprosate (Campral) — Campral, the branded version of acamprosate, has been discontinued. Therefore, Campral (acamprosate) is no longer available, but you still can get the generic versions of acamprosate.
Naltrexone (ReVia, Depade, Vivitrol) — ReVia and Depade are available as oral medications, and Vivitrol is an extended-release injection.

In addition, disulfiram (Antabuse), which is used in the treatment of alcohol use disorder, also has some anti-craving effects.

Tiapride is used in the treatment of alcohol withdrawal syndrome in Europe but is not available and approved for this purpose in the US.

What is acamprosate?

Acamprosate is a prescription medication that is structurally similar to two neurotransmitters called gamma-aminobutyric acid (GABA) and taurine. Neurotransmitters are the natural brain chemicals essential for carrying signals to facilitate communication between the central nervous system and the rest of the body and vice versa.

Excessive alcohol consumption affects the balance of certain neurotransmitters. Acamprosate’s exact mechanism of action is unknown. However, it is believed that this medication helps modulate the brain activity that has been off-balance due to the excessive excitation caused by alcohol dependence.

Acamprosate is prescribed to help maintain alcohol abstinence in people who used to drink alcohol and have stopped drinking and are starting treatment for alcohol use disorders. The use of acamprosate to treat alcoholism is part of a comprehensive program that includes counseling, behavioral therapy, and mutual support groups.

How does acamprosate work?

The exact mechanism of how acamprosate works to help maintain alcohol abstinence is unclear. Chronic alcohol exposure is believed to alter the normal balance between excitation and inhibition of nerve cells in the brain. Animal studies have shown that acamprosate might interact with glutamate and GABA neurotransmitters in the central nervous system and restore this balance.

What are cravings?

Cravings are strong desires or urges to consume alcohol. They can occur spontaneously or be triggered by internal or external stimuli. Examples of internal triggers include anxiety or symptoms of alcohol withdrawal, such as jittery, nausea, and tremors. External triggers include exposure to alcohol-related objects or environments, such as bottles of alcoholic beverages, bars, or stressful situations and emotional distress. High levels of cravings are associated with an increased risk of relapse in people with alcohol addiction. Treatments that reduce cravings can decrease the probability of subsequent alcohol use and help a person successfully quit drinking.

Does acamprosate reduce cravings?

Studies have shown that acamprosate can significantly increase the chances of remaining abstinent from alcohol as well as the duration of abstinence. But its effects on cravings are variable. Higher doses of acamprosate may reduce cravings 3 months after quitting when cravings tend to be strongest. Some studies have shown that acamprosate produces marked reductions in cravings among severe alcoholics who have the highest initial cravings. Other studies have found that a reduction in cravings is highly variable and does not correlate with drinking behavior.

Does acamprosate reduce symptoms of alcohol withdrawal?

Acamprosate does not reduce or eliminate symptoms of alcohol withdrawal. Other medications (benzodiazepines) are more effective in managing withdrawal symptoms during detoxification from alcohol in a controlled setting, such as outpatient or inpatient drug and alcohol rehab centers.

How to take acamprosate?

Acamprosate comes in the form of a delayed-release tablet to take by mouth. The tablets should be swallowed whole without cutting, chewing, or crushing them. The medicine is typically prescribed at a dose of 666 mg (two 333 mg tablets) three times daily. You can take the tablets with or without food. It is easier to remember to take the medicine if you take it with your three major meals (breakfast, lunch, and dinner). This helps maintain a steady state of the drug in your body and provides the best outcomes.

Do not take a higher dose or take the medicine more frequently than prescribed by your healthcare provider.

The effects of acamprosate to prevent drinking are present only when you are taking the medicine. Continue acamprosate as directed by your healthcare provider, even if you don’t plan on drinking alcohol. Do not stop it without talking to your healthcare provider. If you relapse and resume drinking alcohol while on acamprosate, continue the medicine and call your healthcare provider.

Unlike disulfiram (Antabuse), acamprosate does not cause an unpleasant reaction if you drink during treatment, whereas disulfiram blocks an enzyme that causes unpleasant symptoms if you drink during treatment.

What are the side effects of taking acamprosate for alcohol dependence?

Common side effects of acamprosate include flatulence, nausea, diarrhea, loss of appetite, dizziness, weakness, dry mouth, itching, sweating, sleep disturbances, and anxiety. Tell your healthcare provider if these side effects are severe or persistent after a few days. Call your doctor immediately or seek emergency medical care if you develop severe side effects such as a skin rash or burning, tingling, or numbness sensations in the limbs.

Who should not take acamprosate?

People who have had an allergic reaction to acamprosate in the past should not take this medicine. Also, those with severe renal impairment (chronic kidney disease) should not take acamprosate. People with moderate kidney disease may be prescribed a lower dose of acamprosate.

Other negative effects of acamprosate include an increased risk of suicidality. People who are treated with this medicine were found to have a higher risk of suicidal thoughts and behaviors. Tell your doctor if you have a history of mental illness or suicidal ideation before starting treatment. Families and caregivers of patients being treated with acamprosate should be educated about this potential adverse effect so they can monitor the patients for any changes in mood and behaviors or any emergence of depression or suicidal thoughts.

Give your doctor a complete list of medications before starting acamprosate to avoid any potentially dangerous or life-threatening drug interactions. Check with your prescribing doctor before starting any new medication while on acamprosate treatment for alcohol dependence.

How effective is acamprosate for alcohol use disorder?

A meta-analysis of randomized controlled trials in the National Library of Medicine found that when acamprosate significantly reduces the risk of returning to drinking by 86% and increases the duration of abstinence by 11% compared to placebo. Even after treatment with acamprosate is discontinued, people who received acamprosate have a lower risk of returning to drinking and a higher abstinence duration. Studies have also shown that acamprosate is more effective in maintaining abstinence when it is combined with psychotherapy such as talk therapy and support groups.

Acamprosate vs naltrexone vs disulfiram: Which is better for alcohol dependence?

The three medications that are FDA-approved for alcohol dependence are naltrexone, disulfiram, and acamprosate. Acamprosate is unique because it is not metabolized by the liver or impacted by alcohol use during treatment. Liver damage is common in people with alcohol dependence, and one of the advantages of acamprosate therapy is that this medication can be prescribed to people with hepatitis or mild to moderate liver disease. Additionally, unlike disulfiram, acamprosate does not cause an unpleasant reaction if a person drinks during treatment. While naltrexone does not cause the unpleasant effects in the presence of alcohol like disulfiram, naltrexone blunts the euphoric effects associated with intoxication.

Studies have shown that acamprosate reduces the risk of returning to drinking and increases the duration for which a person can maintain abstinence. In terms of comparison between the three medications, when it comes to treating alcohol dependence, acamprosate and naltrexone are first-line treatments, and disulfiram is considered second-line. Notably, the combination of acamprosate and naltrexone is considered the best choice for the prevention of relapse, along with positive reinforcement with psychotherapy such as cognitive-behavioral therapy.

Along with these three FDA-approved medications, topiramate, an anticonvulsant, and some serotonergic agents such as fluoxetine and ondansetron have been shown to increase abstinence rates in people with alcohol dependence. Further research is necessary to learn more about the role of other medications in the treatment of alcohol dependence.

How long is acamprosate used for?

Treatment with acamprosate should be started as soon as possible after alcohol withdrawal once you achieve abstinence. The medicine should be continued during relapses. You should continue taking acamprosate even if you don’t see any immediate improvement or are not at risk of drinking alcohol again. The usual treatment duration with acamprosate is about 6 months, but clinicians can choose to extend the treatment for up to 12 months if necessary.

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