Acamprosate
Alcohol is the seventh leading risk factor for death and disability globally. In ages 20–38, 13.5% of deaths are alcohol-related. In India, 29% of men and 1% of women (15–49 years) use alcohol; Tamil Nadu studies show 16.8–42.7% prevalence.
Alcohol Use Disorder (AUD)
- Chronic alcohol use leads to tolerance, withdrawal, cravings, impaired control, and health/social problems.
- Goal of treatment: Reduce or stop alcohol intake via medication and behavioral
| S.NO | Treatment | Examples with usual dose |
|---|---|---|
| 1. | First-line treatment | • Oral naltrexone - 50 mg/day • Depot naltrexone - 380 mg every four weeks (IM only) • Acamprosate - 666 mg three times daily |
| 2 | Second-line treatment | • Disulfiram -500 mg/day for one-to-two-week f/b 250 mg/day • Topiramate - 50 mg/day (Max: 150 mg BD) • Baclofen – 10 mg TDS (30 mg/day) • Nalmefene & Gabapentin |
Focus on Acamprosate
- Pharmacologic Category: GABA Agonist/Glutamate
- Mechanism of Action: Restores balance between neuronal excitation and inhibition disrupted in chronic alcohol use; affects NMDA and mGlu5 receptors to rebalance glutamate/GABA
- Availability in India: In India, Acamprosate is available primarily as Acamprosate Calcium in dosages of 333 mg and 666 mg.
- Cost & Brands available in India: Acamprosate is manufactured by several pharmaceutical companies in India, with typical market prices ranging from ₹70 to ₹300 for a strip of 10 tablets: Acamprol (by Sun Pharma), Camosat (by CMG Biotech), Acampure, Accimpak, Akrosite.
Dosing & Frequency:
| Drug name | Usual Dosing | Renal Dosing | Hepatic Dosing |
|---|---|---|---|
| Acamprosate | 666 mg 3 times daily | • CrCl 30 to 50 mL/minute: 333 mg TDS • CrCl ≤30 mL/minute: Use is contraindicated. | No Dosing adjustment needed. |
Duration: Acamprosate is usually taken for at least 3 to 6 months. Treatment thereafter is assessed for each patient.
Administration:
- It typically started 5 days after stopping
- May also begin during medically supervised
- Full effect by 5–8
Side Effects
| Most Common Side Effect | Less Common Side Effects |
|---|---|
| Diarrhea | Suicidal ideation (less common, but serious), Intestinal cramps, Headache, Flatulence, increased or decreased libido, Insomnia, Anxiety, Muscle weakness, Nausea, Itchiness, Dizziness |
Cautions and Contraindications
| Patient Group/Condition | Recommendation |
|---|---|
| Moderate renal impairment | Reduce dose: 333 mg TDS |
| Severe renal impairment | Contraindicated |
| Pregnant/nursing women | Avoid unless benefits outweigh risks (FDA Cat C) |
| Age ≥65 | Check renal function regularly |
| Children/adolescents | Prescribe with caution (limited data) |
Practical guidance
- Naltrexone and acamprosate are first line: Naltrexone preferred for craving/reduction in heavy drinking, acamprosate for maintenance of abstinence after detoxification.
- Disulfiram designated second-line due to compliance issues and risk of serious
- Acamprosate has unique safety in liver disease and concurrent opioid or detox
