Acamprosate: Uses, Side Effects, and More

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Key Takeaways

  • Acamprosate, brand name Campral®, is used to treat alcohol dependence and encourages abstinence after detoxification, when used alongside other forms of support.
  • It modulates neurotransmitter activity in the brain, particularly NMDA receptors and GABAA, to restore balance disrupted by alcohol.
  • Acamprosate is not metabolized by the liver and is excreted unchanged by the kidneys, reducing potential drug interactions.
  • Acamprosate is usually well-tolerated, but it can cause side effects, such as gastrointestinal issues.
  • Severe side effects are rare but may include psychiatric symptoms and cardiovascular problems.
  • It is contraindicated in patients with severe renal impairment and should be used cautiously in those with moderate renal dysfunction.
  • The standard adult dosage is 666 mg three times daily, with adjustments for body weight and renal function.
  • Patients are advised to avoid alcohol while taking acamprosate and to take it on an empty stomach for better absorption.

What Is Acamprosate and What Does It Do?

Acamprosate, sold under the brand name Campral®, is a medication primarily used to treat alcohol dependence. 

Developed by Lipha, a subsidiary of Merck KGaA, acamprosate was first approved in Europe in 1989 and later by the U.S. Food and Drug Administration (FDA) in 2004. The medication is notable for its role in supporting individuals in maintaining abstinence from alcohol after they have stopped drinking. 

Acamprosate helps to stabilize the chemical signals in the brain, thereby reducing the cravings for alcohol that many people experience after they stop drinking. It also reduces post-acute withdrawal symptoms, such as disturbances in sleep and mood, which can trigger relapse. 

Studies have shown that acamprosate can significantly increase the number of abstinent days when compared to a placebo. Clinical trials have reported that patients treated with acamprosate experienced a longer duration before relapsing into heavy drinking. 

It is often prescribed as part of a comprehensive treatment program that includes psychosocial support, as it has been shown to be more effective in conjunction with such support.

It is important to note that acamprosate is not a cure for alcohol dependence but serves as a valuable tool to support individuals in their recovery journey. Further, it is only recommended for those who have achieved abstinence, as it is not effective in reducing the symptoms of acute alcohol withdrawal.

How Does Acamprosate Work? 

Acamprosate’s mechanism of action is not fully understood. 

However, it is believed to restore the balance of excitatory and inhibitory neurotransmitters in the brain that are disrupted by chronic alcohol consumption, particularly by modulating the activity of the NMDA receptors and GABAA receptors.

Acamprosate’s unique mechanism of action does not produce alcohol-like intoxication and has not been associated with dose escalation or dependence. 

Acamprosate is excreted unchanged in the kidneys and has a bioavailability of approximately 11%, meaning that it is not metabolized by the body. This is a unique characteristic that distinguishes it from many other medications. 

Acamprosate: Contraindications & Interactions

Acamprosate is well-tolerated by most people in alcohol addiction recovery, but as with all drugs, it is contraindicated in some cases. It may also interact with other medications, food, or alcohol. 

Contraindications for Acamprosate

Acamprosate is contraindicated in individuals with severe kidney impairment, and caution and careful monitoring are recommended when prescribed to patients with liver disease. Additionally, acamprosate is contraindicated in individuals who have shown hypersensitivity or allergic reactions to acamprosate calcium or any of the other ingredients in the medication.

The safety of acamprosate for pregnant or nursing mothers has not been established, so caution is important for women who are or may become pregnant. 

Additionally, it is important for patients to notify their healthcare practitioner immediately if they experience depression or suicidal thoughts. These types of mental health issues have been reported with acamprosate, though a causal relationship has not been established. 

Acamprosate’s Drug Interactions

One of the key aspects of acamprosate is its interaction profile with other drugs and substances. Notably, acamprosate is not metabolized by the liver and is excreted unchanged in the urine, which suggests a lower potential for drug-drug interactions.  

Acamprosate has no known inducing effect on liver enzymes, which means it is unlikely to affect the metabolism of other medications. While specific interactions with other drugs are not extensively documented, the general principles of pharmacokinetics suggest that drugs affecting renal function could alter acamprosate levels. 

Nevertheless, patients are advised to consult healthcare providers about all medications they are taking, including prescription drugs, over-the-counter medicines, herbals, and dietary supplements, to ensure there are no potential interactions.

Acamprosate’s Interactions with Food & Alcohol

While acamprosate itself is not metabolized in the liver and does not have significant drug interactions, its absorption is affected by food intake. Research indicates that taking food with acamprosate can limit its absorption, suggesting that the medication may be more effective when taken on an empty stomach.

Regarding alcohol interaction, acamprosate is designed to help maintain abstinence in people with alcohol dependence. The medication’s efficacy is contingent upon the patient not consuming alcohol. Patients are advised to avoid alcohol while taking acamprosate, as the combination of acamprosate and alcohol has not been extensively studied.  

Acamprosate Dosage and Administration Guidelines

The typical acamprosate dosage for adults is 666 milligrams taken three times daily, amounting to a total daily dose of 1998 milligrams. This dosage is recommended for individuals with normal renal function and body weight over 60 kilograms (approximately 132 pounds). 

For patients with moderate renal dysfunction, an initial reduced dose of 333 milligrams three times daily is advised. Furthermore, patients weighing less than 60 kilograms may start with a lower dose, such as 333 milligrams twice daily, to mitigate potential side effects.

It is supplied as delayed-release tablets of 333 milligrams, which should be swallowed whole to maintain the integrity of the enteric coating. Crushing or chewing the tablets is not recommended as it can alter the drug’s release profile and effectiveness.

For patients with renal impairment or other health concerns, dosage adjustments may be necessary. 

It is crucial for patients to communicate with their healthcare provider about all medications they are taking to avoid potential drug interactions.

Acamprosate Side Effects 

While side effects aren’t common, individuals prescribed acamprosate should be familiar with some of those that have been documented. 

Common side effects include:

  • Diarrhea
  • Nausea
  • Headaches
  • Dizziness
  • Rash
  • Trouble sleeping
  • Anxiety
  • Nervousness
  • Low energy levels
  • Mood changes

Severe side effects are very rare, but they may include:

  • Allergic reactions
  • Changes in blood pressure
  • Depression 
  • Thoughts of suicide 
  • Hepatitis
  • Pulmonary embolism
  • Convulsions 
  • Encephalopathy
  • Liver cirrhosis
  • Increased liver enzymes
  • Myocardial infarction
  • Heart failure
  • Deep thrombophlebitis

Patients should be aware that this is not an exhaustive list, and other side effects may occur. It’s crucial for patients to report any side effects to their healthcare provider, particularly if they are severe or persistent.  

Signs of Acamprosate Overdose  

It is important for individuals taking Acamprosate to adhere to the prescribed dosages and to be aware of the potential risks associated with overdose. 

Some of the most common symptoms of acamprosate overdose include: 

  • Severe diarrhea
  • Changes in the amount of urine produced
  • Fainting
  • A fast or pounding heartbeat
  • Vision or hearing changes. 

In the event of a suspected overdose, immediate action is critical; call emergency services at 911 and follow the recommendations provided.

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