Acamprosate (Campral)

Question 1

Class

Answer 1

Glutamate multi-modal (modulator)

Question 2

Use

Answer 2

Maintenance of alcohol abstinence

Question 3

MOA

Answer 3

• Inhibits glutamate (excitatory) and increases GABA (inhibitory) action
• Withdrawal of alcohol following chronic alcohol use causes excess glutamate activity and low GABA activity. Acamprosate acts as “artificial alcohol” to reduce these effects

Question 4

How long until it works

Answer 4

13 - 52 weeks

Question 5

Augment with ___ if partial response or t/t resistance

Answer 5

• Naltrexone

* behavioral, educational, supportive groups

Question 6

S/Es

Answer 6

• Diarrhea, Nausea
• Anxiety, depression, behavioral changes
• Suiccidal ideation and behavior

Question 7

What to do abt S/Es

Answer 7

Wait, adjust dose, stop if persistent

Question 8

Dose range and form, how to dose, dosing tips

Answer 8

• Dose-
  less than 60 kg - 666 mg BD
  more than 60 kg - 666 mg TDS

*Form - tablet 333 mg

• Continue even if relapse occurs, disclose new drinking to doctor
• no effect of taking with food, but may increase adherence if asked to take the 3 doses with 3 meals

Question 9

Overdose symptoms

Answer 9

Diarrhea

Question 10

Long term use upto?

Answer 10

1 year

Question 11

Taper or not?

Answer 11

No need

Question 12

half life

Answer 12

20 - 33 hours, excreted unchanged via kidneys

Question 13

Drug interactions

Answer 13

*No CYP effect, no liver metabolism

Question 14

Warnings/Precautions

Answer 14

• Monitor for suicidality, depressed mood

* Cautious in psych pts

Question 15

C/I

Answer 15

• Severe renal impairment

* Allergy

Question 16

Renal, Hepatic, Cardiac, Elderly, Children, Pregnancy, BF

Answer 16

• Renal - C/I in severe impairment; reduce dose to 333 mg TDS in moderate impairment
• Elderly - Monitor renal function, may need lower dose in some pts
• Pregnancy - No studies, but don’t preferred in pregnancy, esp 1st trimester
• BF- Stop drug or bottle feed

Question 17

Potential advantages

Answer 17

• people who recently gave up alcohol

* for chronic daily drinkers

Question 18

Potential disadvantages

Answer 18

• people still drinking while starting acamprosate

* Binge drinkers

Question 19

Primary target symptom

Answer 19

*Alcohol dependence

Question 20

Of note

Answer 20

• Since it acts as artificial alcohol, it may be less effective if pt still drinking or relapsed
• Prefer if goal is complete abstinence, but not preferred if goal is reduced-risk drinking