Acamprol: Clinically Proven Support for Alcohol Dependence Recovery
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Synonyms | |||
Acamprol (acamprosate calcium) is a prescription medication specifically formulated to support the maintenance of abstinence in alcohol-dependent patients who have achieved initial withdrawal and are committed to a comprehensive treatment program. It functions by helping to stabilize the chemical balance in the brain, which is often disrupted by chronic alcohol use, thereby reducing the physiological drive to consume alcohol. This agent is a cornerstone of pharmacological management in addiction medicine, intended for use as part of a broader therapeutic strategy that includes counseling, psychosocial support, and behavioral interventions. Its efficacy is well-documented in clinical trials, demonstrating a significant increase in cumulative abstinence days and a reduction in relapse rates compared to placebo.
Features
- Active ingredient: Acamprosate calcium 333 mg (delivered as two 333 mg enteric-coated tablets per dose)
- Pharmacologic class: Synthetic GABA analogue / glutamate modulator
- Formulation: Delayed-release enteric-coated tablets for optimal gastrointestinal tolerance
- Dosing regimen: Standardized three-times-daily administration, independent of meals
- Prescription status: Schedule IV controlled substance in some jurisdictions; requires medical supervision
- Manufacturing compliance: Produced under current Good Manufacturing Practices (cGMP)
Benefits
- Promotes sustained abstinence by reducing the craving for alcohol in detoxified patients
- Helps renormalize central nervous system neuroadaptation disrupted by chronic alcohol exposure
- Non-habit forming with no abuse potential, supporting long-term therapy adherence
- Demonstrated efficacy in increasing cumulative abstinence duration in multiple randomized controlled trials
- Compatible with comprehensive psychosocial and behavioral treatment programs
- Favorable safety profile with predominantly mild and transient adverse effects
Common use
Acamprol is indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation. It is most effective when incorporated into a complete management program that includes psychological support, counseling, and social reinforcement. Treatment should be initiated as soon as possible after the acute withdrawal period, typically within one week of achieving abstinence, and continued even if the patient experiences a lapse in drinking. The therapeutic effect is cumulative and becomes more pronounced with continued adherence to the prescribed regimen over several weeks to months.
Dosage and direction
The recommended dose of Acamprol is 666 mg (two 333 mg tablets) taken three times daily. Although administration may occur without regard to meals, consistent timing is recommended to maintain stable plasma concentrations. For patients with moderate renal impairment (creatinine clearance 30-50 mL/min), a reduced dosage of 333 mg three times daily is recommended. Acamprol is contraindicated in patients with severe renal impairment (creatinine clearance ≤30 mL/min). Treatment should be continued even during periods of perceived stability, as discontinuation may increase vulnerability to relapse. The duration of therapy should be individualized but often continues for several months to one year, depending on clinical assessment.
Precautions
Acamprol should be used with caution in patients with a history of depression or suicidal ideation, as alcohol-dependent individuals constitute a population at increased risk for these conditions. Renal function should be assessed before initiation and periodically during treatment, particularly in elderly patients or those with conditions predisposing to renal impairment. While Acamprol does not cause sedation or cognitive impairment, patients should be advised regarding the potential for dizziness until they know how the medication affects them. It is not recommended for use during pregnancy unless clearly needed, and breastfeeding should be avoided during therapy due to limited safety data.
Contraindications
Acamprol is contraindicated in patients with severe renal impairment (creatinine clearance ≤30 mL/min) due to significantly reduced elimination and potential accumulation. It should not be administered to patients with known hypersensitivity to acamprosate calcium or any components of the formulation. The medication is not indicated for the management of acute alcohol withdrawal symptoms and should not be initiated until the withdrawal process is complete. Use in pediatric patients has not been established and is not recommended.
Possible side effects
The most commonly reported adverse reactions are gastrointestinal in nature, including diarrhea (approximately 10-17% of patients), nausea, and abdominal pain. These effects are typically mild to moderate in intensity and often diminish with continued therapy. Other reported side effects include pruritus, rash, insomnia, anxiety, and asthenia. Suicidal ideation, though rare, has been reported in post-marketing surveillance and requires immediate medical attention. Most adverse events occur during the initial treatment phase and decrease in frequency with prolonged use.
Drug interaction
Acamprol does not undergo hepatic metabolism and shows low plasma protein binding, minimizing its potential for pharmacokinetic interactions. However, concomitant use with other centrally acting agents, particularly those affecting neurotransmitter systems (e.g., antidepressants, anxiolytics), should be monitored clinically. No clinically significant interactions have been observed with disulfiram, diazepam, or antidepressants in controlled studies. As with any medication, healthcare providers should maintain awareness of all concomitant medications when prescribing Acamprol.
Missed dose
If a dose is missed, patients should take it as soon as they remember unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling of doses to make up for a missed dose is not recommended. Consistent adherence to the prescribed three-times-daily regimen is important for maintaining therapeutic efficacy, and patients should be counseled on strategies to support medication compliance.
Overdose
Experience with Acamprol overdose is limited. Reported cases have involved doses up to 56 grams and were characterized by diarrhea but without other serious clinical consequences. Nevertheless, any suspected overdose should be managed with supportive care directed at presenting symptoms. Gastrointestinal decontamination may be considered if ingestion occurred recently, though the delayed-release formulation may limit effectiveness. There is no specific antidote for acamprosate overdose, and hemodialysis is not expected to enhance elimination significantly due to the drug’s pharmacokinetic properties.
Storage
Acamprol tablets should be stored at room temperature (15-30°C or 59-86°F) in their original container to protect from moisture. The medication should be kept out of reach of children and pets. Unused medication should be disposed of properly according to local regulations, preferably through a medication take-back program, to prevent accidental ingestion or environmental contamination.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Acamprol is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to treatment may vary, and the prescribing physician will determine the appropriate therapy based on the patient’s specific clinical situation. Patients should not adjust their dosage or discontinue treatment without consulting their healthcare provider.
Reviews
Clinical studies demonstrate that Acamprol significantly improves abstinence rates compared to placebo, with meta-analyses showing a number needed to treat (NNT) of approximately 9 for maintaining continuous abstinence. In long-term observational studies, patients receiving Acamprol as part of a comprehensive treatment program report improved quality of life measures and reduced alcohol-related hospitalizations. Healthcare providers consistently note its value as an adjunctive therapy that addresses the neurobiological components of alcohol dependence, particularly when combined with psychosocial interventions. Patient satisfaction surveys indicate that those who maintain adherence to the full treatment course experience meaningful reductions in craving intensity and increased confidence in their recovery journey.