Acamprosate (Campral) tablets

Acamprosate (trade name Campral) is an oral medication in the form of gastro-resistant tablets, containing the active substance Acamprosatum at a dose of 333 mg. It is used for maintenance treatment of alcohol abstinence in people addicted to alcohol — always combined with concurrent psychotherapy.

Acamprosate has a chemical structure similar to naturally occurring neurotransmitters in the brain — taurine and gamma-aminobutyric acid (GABA). Studies have shown that the medication affects alcohol dependence by reducing alcohol consumption without disrupting food and fluid intake.

Mechanism of action

Chronic alcohol consumption disrupts the balance in the brain between two key neurotransmitter systems:

• Glutamatergic system (excitatory) — NMDA receptors become overactive
• GABAergic system (inhibitory) — GABA-A receptors lose proper function

After alcohol cessation, this disrupted balance manifests as hyperexcitability, anxiety, insomnia and strong alcohol craving. Acamprosate restores this balance by:

• Stabilising the glutamatergic system — inhibits excessive NMDA receptor activity characteristic of post-alcohol withdrawal state
• Modulating the GABAergic system — affects GABA-A receptors, restoring proper proportions between excitatory and inhibitory signals

Key principle: Acamprosate does not cause an aversive reaction after consuming alcohol — it does not punish for drinking, as Anticol (disulfiram) does. Instead, it reduces the need to reach for alcohol and alleviates psychological withdrawal symptoms.

In pharmacotherapy of alcoholism, several medications with different mechanisms of action are used. Here is how Acamprosate compares to other preparations:

Acamprosate (Campral) vs Anticol (Disulfiram)

• Mechanism: Acamprosate restores neurotransmitter balance; Anticol causes an aversive reaction (poisoning after alcohol)
• Reaction after alcohol: Acamprosate — none; Anticol — severe, potentially dangerous
• Dosage: Acamprosate 3× daily; Anticol 1× daily
• Occasional drinking: with Acamprosate does not preclude continuation; with Anticol — life-threatening
• Contraindications: Acamprosate — few; Anticol — extensive list
• Drug interactions: Acamprosate — very low risk; Anticol — numerous, dangerous interactions
• Driving: Acamprosate — no effect; Anticol — caution (drowsiness)

Acamprosate vs Naltrexone

• Mechanism: Acamprosate normalises neurotransmitters; Naltrexone blocks opioid receptors
• Required abstinence: Acamprosate — yes (after detox); Naltrexone — no
• Dosage: Acamprosate 3× daily; Naltrexone 1× daily
• Treatment duration: Acamprosate — recommended 1 year; Naltrexone — doctor determines
• Combination: they can be used together (Naltrexone may increase Acamprosate levels)

Acamprosate vs Nalmefen (Selincro)

• Goal: Acamprosate supports abstinence; Nalmefen serves drinking reduction
• Dosage: Acamprosate daily 3× per day; Nalmefen "as needed" (before planned drinking)
• Required abstinence: Acamprosate — yes; Nalmefen — no

Summary: Acamprosate is a medication with the best safety profile among alcoholism medications — lowest interaction risk, no effect on driving, mild side effect profile. It is ideal for post-detox patients whose goal is long-term abstinence maintenance.

Acamprosate is indicated for maintenance treatment of alcohol abstinence in people addicted to alcohol. It is crucial that the medication must be used with concurrent psychotherapy — the medication alone is not enough.

Best candidates for Acamprosate treatment

• Post-detox patients — the medication should be started as soon as possible after alcohol cessation
• People with strong alcohol craving — Acamprosate directly reduces craving
• Patients with persistent withdrawal symptoms — anxiety, insomnia, irritability after alcohol cessation
• People for whom disulfiram is contraindicated — significantly shorter contraindication list
• Patients taking multiple medications — very low interaction risk
• People who drive — the medication does not affect driving ability
• Patients preferring a medication that "doesn't punish" — no aversive reaction after alcohol

Age restrictions

Safety and efficacy of Campral use have not been established in patients:

• Under 18 years — not recommended
• Over 65 years — not recommended

The medication is intended for adults aged 18–65 years.

Important information

Campral is not indicated for treating acute alcohol withdrawal symptoms (e.g. delirium tremens, seizures). This requires detoxification under medical supervision. Acamprosate is started after detox, as support for maintaining abstinence.

Campral should always be used according to the doctor's instructions. If in doubt, consult your doctor or pharmacist.

Dosage schedule

• Body weight 60 kg or more: 2 tablets (666 mg) three times daily — morning, midday and before bed
• Body weight below 60 kg: 4 tablets in three divided doses — 2 tablets morning, 1 midday and 1 before bed

Practical tips

• Time of administration: it is recommended to take the medication between meals. Concurrent food intake reduces absorption — this is important information that patients often forget.
• How to take: swallow tablets whole with water. Do not crush or chew — the tablets have a gastro-resistant coating that protects the active substance from degradation in the stomach.
• Starting treatment: as soon as possible after alcohol cessation (after detox).
• Treatment duration: the recommended treatment period is 1 year.

Occasional alcohol consumption

This is a key difference compared to disulfiram: an occasional episode of drinking is not a contraindication to continuing treatment with Acamprosate. A one-time "slip" does not mean treatment must be stopped — on the contrary, the patient should continue the medication and discuss the situation with their therapist.

Missed dose

If a dose is missed, take the next planned dose at the scheduled time. Do not take a double dose to make up for the missed one.

If the patient feels the medication's effect is too strong or too weak, they should contact their doctor.

The list of absolute contraindications for Acamprosate is significantly shorter than for Anticol (disulfiram) — this is one of the reasons the medication is considered safe.

Absolute contraindications (must not be used)

• Hypersensitivity to acamprosate or any of the excipients
• Kidney function disorders — serum creatinine level above 120 micromol/l. Acamprosate is excreted mainly through the kidneys, so their proper function is crucial.
• Breastfeeding — the medication passes into animal milk; no human data available; must not be used by breastfeeding women.

Conditions requiring special caution

• Severe hepatic insufficiency — safety and efficacy have not been established in these patients
• Depression and suicidal tendencies — there is a well-known and complex interrelationship between alcohol dependence, depression and suicide. Patients treated with Acamprosate should be monitored for typical symptoms.

Comparison with Anticol

For context: Anticol (oral disulfiram) has a much broader list of absolute contraindications — including diabetes, heart failure, severe respiratory, kidney and liver failure, psychiatric disorders, and pregnancy is absolutely excluded. Acamprosate has a significantly better safety profile in this regard.

Although Acamprosate is considered a safe medication, there are several important issues the patient should be aware of:

No aversive reaction — but abstinence still necessary

Acamprosate does not cause a negative reaction after consuming alcohol. Concurrent alcohol consumption does not affect the action of either alcohol or acamprosate. However, this does not mean drinking is safe — the goal of therapy is to maintain abstinence, and the medication is a tool supporting this process.

The medication does not treat acute withdrawal symptoms

Campral is not indicated for treating acute alcohol withdrawal symptoms — such as seizures, alcohol delirium (delirium tremens) or severe psychomotor agitation. This requires professional detoxification. Acamprosate is started after detox completion.

Psychotherapy is essential

The medication is part of a comprehensive therapeutic programme. Acamprosate alone will not cure addiction — it must be accompanied by addiction psychotherapy and therapeutic support. The medication gives the patient a "window of sobriety" in which they can effectively work on the causes of drinking.

Mood monitoring

People addicted to alcohol are at risk of mood disorders, depression and suicidal thoughts. The patient should immediately inform their doctor about any symptoms of mood deterioration, increased anxiety or suicidal thoughts.

The medication is not addictive

Non-clinical studies indicate that acamprosate has no or minimal potential for causing medication dependence. This is important information for patients with addictive personalities who may fear replacing one addiction with another.

One of the greatest advantages of Acamprosate is its very low risk of drug interactions. This medication is exceptionally well tolerated in combination with other preparations — unlike disulfiram (Anticol), which enters into numerous dangerous interactions.

Safe combinations (confirmed in studies)

No changes in the frequency of clinical and/or biological adverse reactions were observed with concomitant use of acamprosate with:

• Disulfiram (Anticol / Esperal) — medications can be combined
• Oxazepam (sedative from the benzodiazepine group)
• Tetrabamatum and meprobamate (sedatives)

In clinical trials, Acamprosate was safely used in combination with:

• Antidepressants
• Anxiolytics
• Hypnotics and sedatives
• Non-opioid analgesics

Combination with Naltrexone

Concomitant use of Acamprosate with Naltrexone may slightly increase acamprosate blood levels. This combination is sometimes used in clinical practice under medical supervision.

Alcohol + Campral

Concurrent alcohol consumption with Campral does not affect the action of alcohol or acamprosate. The medication neither enhances nor weakens the effects of alcohol — this is a fundamental difference compared to disulfiram, where alcohol causes a dangerous reaction.

Like all medicines, Campral can cause side effects, although not everybody gets them. The side effect profile of Acamprosate is mild — significantly milder than with disulfiram.

Very common (more frequently than 1 in 10 patients)

• Diarrhoea — the most common side effect; usually transient, subsides during treatment. This is information the patient must know.

Common (1 to 10 in 100 patients)

• Gastrointestinal disorders: abdominal pain, nausea, vomiting, flatulence
• Skin symptoms: itching, maculopapular rash
• Sexual disorders: frigidity or impotence, decreased libido

Uncommon (1 to 10 in 1,000 patients)

• Increased libido

Very rare (less than 1 in 10,000 patients)

Hypersensitivity reactions, including:

• Urticaria
• Angioedema — swelling involving deeper layers of skin and subcutaneous tissue, which may involve mucous membranes; often localised in the facial area (eyelids, lips), but may affect virtually any body area, as well as the gastrointestinal tract, respiratory and urinary systems
• Anaphylactic reactions — itching, whole body erythema, urticaria of varying severity, sudden drop in blood pressure, increased or less commonly decreased heart rate, dyspnoea, difficulty breathing due to laryngeal oedema, cramping abdominal pain, vomiting, diarrhoea (sometimes bloody)

Frequency unknown

• Vesiculobullous eruptions (blistering skin lesions)

Important: If any side effects occur — including those not listed above — inform your doctor. Do not stop treatment on your own.

The toxicity profile of Acamprosate in overdose is mild — this is a significant difference compared to disulfiram, where overdose can be life-threatening.

Overdose symptoms

If a higher than recommended dose of Campral is taken, the main symptom is usually diarrhoea.

Management

Contact your doctor. The doctor will apply symptomatic treatment depending on the severity of symptoms.

Comparison with other medications

For context: Anticol (disulfiram) overdose can lead to seizures, coma, circulatory collapse and neurological disorders persisting for several days. Naltrexone overdose may cause liver damage. Acamprosate is the safest medication in alcoholism pharmacotherapy in this regard.

Pregnancy

There are no adequate data on the use of Campral in pregnant women. Animal studies showed no evidence of toxic and teratogenic effects on the foetus.

Campral may be used during pregnancy only after careful assessment of the benefit-risk ratio — when the patient cannot refrain from drinking alcohol without treatment with Campral, and consequently there is a risk of toxic and teratogenic effects of alcohol itself on the foetus.

Comparison with Anticol: Anticol (disulfiram) is absolutely contraindicated in pregnancy — regardless of trimester. Campral has a more favourable profile here: the doctor may consider its use if the benefit (protecting the foetus from alcohol) outweighs the potential risk.

Breastfeeding

Campral passes into the milk of nursing animals. It is not known whether acamprosate passes into human milk. Due to insufficient data on the use of acamprosate in infants, Campral must not be used by breastfeeding women.

Fertility

No adverse effects on fertility were observed in animal studies. It is not known whether acamprosate affects fertility in humans.

Driving and operating machinery

Campral does not affect the ability to drive and operate machinery. This is a significant advantage over Anticol (disulfiram), which may cause drowsiness and fatigue requiring caution behind the wheel.

For patients for whom driving is essential in daily life (commuting to work, family responsibilities), Acamprosate is one of the most convenient medications in alcoholism pharmacotherapy.

Medication composition

• Active substance: Acamprosate (Acamprosatum), 333 mg per tablet
• Form: gastro-resistant film-coated tablets — tablets must not be crushed or chewed, the gastro-resistant coating protects the active substance from degradation in the stomach
• Excipients: crospovidone, microcrystalline cellulose, magnesium silicate, sodium starch glycolate, colloidal anhydrous silica, magnesium stearate, methacrylic acid and ethyl acrylate copolymer (1:1) dispersion 30%, talc, propylene glycol

Sodium content

The medication contains less than 1 mmol (23 mg) of sodium per tablet — the medication is considered "sodium-free". This is important information for patients on a low-sodium diet.

Pack sizes

Campral is available in packs of 60, 84, 180 or 200 tablets. Not all pack sizes may be marketed in every country.

Acamprosate (Campral) is a prescription medication — it is not available over the counter. Here is how the treatment process works:

1. Detoxification — if the patient is still drinking, the first step is alcohol detox under medical supervision. Acamprosate is started after alcohol cessation.
2. Medical consultation — in person or online. The doctor conducts a medical interview, verifies contraindications (including kidney function) and establishes an individual treatment plan.
3. Issuing an e-prescription — if there are no contraindications, the doctor issues an electronic prescription that the patient fills at any pharmacy.
4. Starting treatment — the medication is started as soon as possible after alcohol cessation. First dose according to the weight-based schedule.
5. Concurrent psychotherapy — treatment must include addiction psychotherapy. The medication alone is not enough.
6. Regular check-up visits — the doctor monitors medication tolerance throughout the recommended year of treatment.

Acamprosate is most effective when used as part of comprehensive therapy — combined with psychotherapy, group support and regular contact with a therapist. The medication provides the patient with valuable neurochemical support that reduces alcohol craving and facilitates maintaining abstinence during the most difficult first year after alcohol cessation.