Acamprosate medication for alcohol dependence, benefits and side effects
September 20 2017 by
Ray Sahelian, M.D.

Acamprosate is an alcohol abstinence promoting drug widely used in the treatment of alcohol dependence but which has a mechanism of action that has remained obscure for many years. Recently, evidence has emerged that it  may interact with excitatory glutamatergic neurotransmission in general and as an antagonist of the metabotropic glutamate receptor subtype 5 (mGluR5) in particular.

Natural pills for alcohol abstinence
For alcohol abstinence, consider learning more about an herb called kudzu.

Acamprosate drug benefit
Campral delayed-release tablet, a synthetic compound with a similar structure to that of the neurotransmitter GABA and the neuromodulator taurine, facilitates the maintenance of abstinence in detoxified alcohol-dependent patients.

How it works
Although the precise mechanism (s) of action of acamprosate remains to be fully understood, it appears that it most likely involves beneficial modulation of the glutamatergic neurotransmitter system, to counteract the imbalance between the glutamatergic and GABA ergic systems associated with chronic alcohol exposure and alcohol withdrawal.

Research
In several double-blind, placebo-controlled trials of up to 12 months duration, use of the drug effectively maintained complete abstinence in detoxified alcohol-dependent patients, irrespective of disease severity or the type of psychosocial support. Acamprosate showed better efficacy than placebo and was well tolerated. Limited data from a relatively well designed trial indicate that acamprosate has similar efficacy to that of naltrexone and that combination therapy with these two agents provides better efficacy than acamprosate monotherapy. Acamprosate may be particularly useful in those with hepatic impairment and/or liver disease. Thus, in combination with psychosocial and behavioural management programs, it is a promising option for the maintenance of abstinence in alcohol-dependent patients after alcohol withdrawal.

Int J Environ Res Public Health. 2014. Six-month outcome in bipolar spectrum alcoholics treated with acamprosate after detoxification: a retrospective study. Glutamate system is modified by ethanol and contributes both to the euphoric and the dysphoric consequences of intoxication, but there is now growing evidence that the glutamatergic system also plays a central role in the neurobiology and treatment of mood disorders, including major depressive disorders and bipolar disorders. We speculate that, using acamprosate, patients with bipolar depression (BIP-A) can take advantage of the anti-glutamate effect of acamprosate to "survive" in treatment longer than peers suffering from non-bipolar depression (NBIP-A) after detoxification. We retrospectively evaluated the efficacy of a long-term (six-month) acamprosate treatment, after alcohol detoxification, in 41 patients (19 males and 22 females), who could be classified as depressed alcoholics, while taking into account the presence/absence of bipolarity. During the period of observation most NBIP-A patients relapsed, whereas a majority of BIP-A patients were still in treatment at the end of their period of observation. The cumulative proportion of 'surviving' patients was significantly higher in BIP-A patients, but this finding was not related to gender or to other demographic or clinically investigated characteristics. The treatment time effect was significant in both subgroups. The treatment time-group effect was significant (and significantly better) for bipolar patients on account of changes in the severity of their illness.

Acamprosate tinnitus information
Treatment of tinnitus with acamprosate.
Prog Brain Research 2007. OTOSUL, Otorrinolaringologia Sul-Fluminense, Volta Redonda, Vila Santa Cecília, Rio de Janeiro, Brazil.
Acamprosate, a drug used to treat alcohol dependence, was first reported as a potential treatment for tinnitus in 2005. The drug may improve tinnitus by a dual mechanism of action, acting both as a glutamate antagonist and as a GABA agonist. It is suggested that its action may be both on the ear and the nervous system.

Product name
Campral (acamprosate calcium) is supplied in an enteric-coated tablet for oral administration. Acamprosate calcium is a synthetic compound with a chemical structure similar to that of the endogenous amino acid homotaurine, which is a structural analogue of homotaurine, which is a structural analogue of the amino acid neurotransmitter γ-aminobutyric acid and the amino acid neuromodulator taurine. Its chemical name is calcium acetylaminopropane sulfonate.

Interactions with natural pills
Can acomprosate be taken the same day as tribulus terrestris extract? What about together with a multivitamin pill. Any information would be helpful.
   We prefer not to mix potent herbs and drugs the same day, unexpected reactions could occur. However, if you have tried each one separately and have not had any adverse effects, you may combine low dosages if your doctor approves.