Acamprosate Treatment & Support Program for Opioid Addiction

Acamprosate (brand name Campral) is an anti-addiction medication that can help to reduce cravings and urges to drink alcohol in people who are dependent on alcohol but want to quit.

While disulfiram works by making someone sick if they drink alcohol and naltrexone blocks the “high” people get when drinking, acamprosate diminishes the physical distress and emotional discomfort people usually experience after they quit drinking.

When it’s used as part of a comprehensive alcohol addiction treatment program like the one at Enterhealth that includes behavioral therapy and counseling, acamprosate has proven to be quite effective, and the U.S. Food and Drug Administration approved it for widespread use in 2004.

While the exact mechanism of action is unknown, it’s believed that acamprosate helps by restoring the balance of two neurotransmitters in the brain (GABA and Glutamate) that get disrupted by long-term or chronic alcohol abuse. By doing this, it helps the brain to begin working normally again and allows patients in recovery to maintain sobriety from alcohol more easily.

GABA and glutamate are important neurotransmitters because they are responsible for controlling the inhibitory (GABA) and excitatory (glutamate) systems in our brains. As the names would suggest, the inhibitory system is the mechanism that tells the brain to calm down, and the excitatory system tells the brain to get energized or excited.

Another way to look at these two important systems is to take an analogy of a car. The GABA system is like the brakes and allows us to slow down, while the glutamate system acts like the accelerator. If you have a car with only one system or the other, it’s not a very functional car – you need both systems to balance each other out in order to be able to use the car effectively.

When a person drinks alcohol (not just an alcoholic, but anyone), it stimulates the GABA system in the brain and the person becomes sedated and relaxed (the brakes slow you down).  At the same time, the glutamate system is suppressed (so the accelerator is not being pressed). When the alcohol wears off, your excitatory system “rebounds” and you feel more irritable, agitated, and may find it difficult to sleep (remember: the brakes are now off, and the accelerator is being pushed).

In an alcoholic, chronic drinking causes the body to develop a tolerance – meaning it takes more alcohol to achieve the same effect. This modifies the GABA/glutamate systems over time, which means alcoholics need to consume more and more alcohol to “put on the brakes” (slow down and relax).

When the alcohol eventually wears off, the glutamate system has become somewhat “turbocharged” and the result is that the accelerator seems to be “pressed to the floor” resulting in quite severe withdrawal symptoms in many cases. This can cause the person to crave alcohol to relieve these uncomfortable symptoms.

By restoring these chemicals in the brain to normal levels, acamprosate makes it easier for people in recovery to maintain their sobriety and participate fully in therapy and counseling.

Fortunately, the side effects of acamprosate, like similar anti-addiction medications, are minimal.

The most common one is diarrhea, and this is usually infrequent, especially after the first 1-3 days of taking the drug. If diarrhea does occur, over-the-counter medications, such as Imodium, are very effective.

Other, less common acamprosate side effects include:

• loss of appetite
• nausea
• fatigue
• intestinal gas
• constipation
• dizziness
• anxiety
• itching
• sweating
• vision problems
• headache
• depressed mood
• sleep problems
• dry mouth
• pain or weakness in muscles/joints

Most of these do not require medical attention and will most likely go away once the body adjusts to the medication. Ask your doctor about ways you can prevent or reduce some of these side effects.

Acamprosate can lead to mental or mood changes in some patients. Speak to your doctor if you experience severe anxiety or depression, or thoughts about suicide or hurting yourself.

Get emergency medical help if you have any signs of an allergic reaction to acamprosate, including:

• hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Most patients remain on acamprosate for at least a year and a half and then, depending on how they are doing in their recovery program, they and their physician can consider and discuss discontinuing it.

As with other medications approved for the treatment of addiction and substance abuse, acamprosate is most effective when it’s used in combination with other components of a complete treatment plan, including behavioral therapy, counseling and/or participation in support groups.

From a scientific standpoint, 14 out of 16 controlled clinical trials in European countries demonstrated evidence for its effectiveness, showing that patients treated with acamprosate have a significantly greater rate of treatment completion, time to first drink, and abstinence rates compared to patients treated with a placebo.

More recent studies by the National Institutes of Health have found that acamprosate may reduce the risk of relapse by as much as 86% and increase the amount of time patients stay abstinent by 11%. Patients who took acamprosate also had a 9% lower risk of returning to drinking within 3 to 12 months after discontinuing treatment.

Unfortunately, the improvements that come with acamprosate take at least a month (4-6 weeks) to become apparent. It can be hard for alcoholic patients to wait that long because they are so accustomed to instant gratification, and some get impatient and stop the anti-addiction medication prematurely.

Also, when the positive effects do begin to appear, they usually develop slowly over 2-4 weeks without an overt, pronounced effect. But one day, 6-10 weeks after starting the acamprosate, alcoholic patients report they notice they are just “a lot better” – more relaxed, sleeping better, and with significantly reduced alcohol cravings.

The other challenge is actually taking the medication.

Acamprosate is not well absorbed by the body. In fact, only about 10% of each pill is absorbed. So, in order to get the necessary 200mg/day into the patient’s bloodstream, patients need to take six tablets per day (1998 mg) for the medication to work.

Addiction patients usually take 2 tablets 3 times a day, but it can be difficult for anyone to take any medication 3 times a day without forgetting that middle-of-the-day dose. Therefore, Enterhealth usually prescribes 2 tablets 3 times a day for the first 2 weeks and then changes to taking 3 tablets twice a day thereafter, not requiring patients to take the lunchtime or mid-day doses.

Finally, some alcoholics are resistant to taking medication to help them because they are not truly committed to stopping alcohol. Regardless, they can be strongly encouraged (and required, if possible) to take the medications and then encouraged to work through their ambivalent feelings about starting in a treatment program and/or attending AA meetings while the medication is starting to help them feel better.

It’s important to take acamprosate exactly as prescribed by a physician and to follow all directions on the prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Acamprosate isn’t usually started until about five days after stopping drinking. However, it is safe to take with alcohol (or with benzodiazepines), meaning it is possible to start taking it before acute withdrawal is complete.

Patients should continue to take the medication for the full prescribed length of time, even if they relapse and drink alcohol. If you are taking acamprosate, it’s important to tell your doctor about any alcoholic drinks you consume.

The drug is also safe in combination with opiates and is therefore considered to be particularly appropriate for patients who are also being treated for opiate addiction. In fact, combining acamprosate with naltrexone or disulfiram may be more effective than using either one alone.

What happens if I miss a dose?

If you miss a dose, it’s okay to take it as soon as you remember, unless it’s almost time for your next scheduled dose. Don’t take extra medicine to make up a missed dose.