Acamprosate for long-term management of alcohol dependence

Acamprosate reduces neuronal hyperexcitability, has a mildly anxiolytic effect, and attenuates the desire to drink. While not an effective treatment for acute alcohol withdrawal, acamprosate may reduce some post-acute withdrawal symptoms, such as anxiety, irritability and cravings. It increases the time to first drink, prolongs abstinence, and reduces the number of drinking daysKim, 2018Rosner, Hackl-Herrwerth, Leucht, Vecchi, 2010 764Swift, 2015. Acamprosate combined with psychosocial treatment significantly improves treatment outcomes compared to psychosocial treatment alone.

Acamprosate is renally cleared; seek specialist advice before prescribing for patients with kidney impairment. Liver disease is generally not a limitation because acamprosate has minimal hepatic metabolism.

Acamprosate must be taken 3 times a day to maintain effect because of rapid renal clearance. Frequent dosing, together with the inconvenience of taking 2 large tablets at each dose, makes acamprosate less popular; it is generally only used as a first choice in patients whose options are limited by liver disease.

If acamprosate is considered appropriate for long-term management of alcohol dependence, start after withdrawal symptoms have resolved (usually 3 to 7 days after the last drink); use:

Treatment is usually for 6 to 12 months, occasionally longer.