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Acamprosate (Campral):
Medication for Alcohol Abuse and Alcoholism Treatment

 
by Mary Ann Elchisak, Ph.D.;  01/18/2001. Originally posted in 2001. Modified: 2006-06-04.
[Identifier: http://www.doctordeluca.com/Documents/AcamprosateSummary.htm]
 
See also:
Can Campral Cure Alcohol Abuse? - Suzanne Anderson; Journal of Addictive Disorders; 2004. Posted: 2005-12-20
 
Pharmacotherapy of Substance Use Disorders Collection: including special sections on Acamprosate, Naltrexone, and Disulfiram
 
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Previous reviews of pharmacologic treatments for alcohol dependence have focused on opiate antagonists, such as naltrexone (ReVia) and nalmefene (Revex).

This review focuses on acamprosate (Campral), which is another type of drug that may help alcoholics maintain abstinence by preventing relapse. This drug is not yet approved for use in the United States. In studies in Europe, Campral appeared to decrease the return to drinking, following a brief period of abstinence, that is typical of alcohol dependence. Campral does not work through opiate receptors, but is commonly thought to work by modifying the
action of GABA, a neurotransmitter. The evidence for action via GABA receptors is based on structural similarities and in vitro data, and Campral does not share most of the other effects of GABA receptor modifying drugs. It's therefore likely that the effects of Campral are mediated some other way. When that mechanism is determined, it may open up new avenues for development of other, more effective medications for alcoholism treatment.

CampralŪ

What is Campral used for?

Campral may may help alcoholics maintain abstinence by preventing relapse. Campral (acamprosate) is not yet approved in the U.S. for alcoholism treatment, but limited clinical trials and use in Europe indicate that it is effective for decreasing relapse to heavy drinking in abstinent alcoholics. Like other drugs used to prevent relapse in recovering alcoholics, Campral is thought to reduce the pleasurable effects of alcohol ingestion. The purpose is to help the patient maintain abstinence until adequate self-motivation for abstinence has been established. Campral will not produce an Antabuse-like reaction if alcohol is ingested while receiving the drug.

Acamprosate might also be an option for recovering alcoholic patients for whom other medications (such as disulfiram and naltrexone) are ineffective in decreasing relapse, or for those who experience serious or intolerable side effects from the other drugs. One advantage of acamprosate is that it not substantially metabolized (inactivated) in the liver, and can, therefore, it can be used even in alcoholics with liver disease.

Mechanism:

Campral (acamprosate) has in vitro affinity for GABA type A and GABA type B receptors, so it's been assumed that the therapeutic effects of acamprosate are due to actions on GABA receptors. However, acamprosate does not share most of the other effects of GABA receptor modifying drugs, such as antianxiety, hypnotic, or muscle relaxant activity. It is therefore possible, perhaps likely, that the effects are mediated some other way. Acamprosate is structurally related to l-glutamic acid (l-gutamate), which is an excitatory neurotransmitter. It's been proposed that acamprosate decreases the effects of the naturally-occurring excitatory neurotransmitter glutamate in the body. Since chronic alcohol consumption disrupts this system, and the changes last many months after alcohol ingestion is stopped, it's possible that acamprosate somehow restores the glutamate system towards normal. It's thought, no matter how it acts, that Campral decreases the pleasant "high" associated with alcohol consumption, and thus decrease the frequency of relapse during abstinence.

Contraindications:

Campral should not be used or used with caution if any of the following conditions are present:

• pregnant women and lactating women
   
• kidney disease
   
• very severe liver disease

Side effects:

• diarrhea
   
• dyspepsia (indigestion)
   
• headache
   
• nausea and vomiting
   
• rash, itching
  

Drug Interactions:

Interactions of Campral (acamprosate) with other medications are not well-studied. However, Campral does not appear to interact with other medications often used during alcoholism treatment, such as disulfiram (Antabuse) and naltrexone (ReVia), or with antianxiety, antidepressant, or hypnotic (sleep-inducing) medications. Additional drug interaction information should be forthcoming.