Acamprosate (Campral) Flashcards
Class
Glutamate multi-modal (modulator)
Use
Maintenance of alcohol abstinence
MOA
- 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
How long until it works
13 - 52 weeks
Augment with ___ if partial response or t/t resistance
- Naltrexone
* behavioral, educational, supportive groups
S/Es
- Diarrhea, Nausea
- Anxiety, depression, behavioral changes
- Suiccidal ideation and behavior
What to do abt S/Es
Wait, adjust dose, stop if persistent
Dose range and form, how to dose, dosing tips
- 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
Overdose symptoms
Diarrhea
Long term use upto?
1 year
Taper or not?
No need
half life
20 - 33 hours, excreted unchanged via kidneys
Drug interactions
*No CYP effect, no liver metabolism
Warnings/Precautions
- Monitor for suicidality, depressed mood
* Cautious in psych pts
C/I
- Severe renal impairment
* Allergy
Renal, Hepatic, Cardiac, Elderly, Children, Pregnancy, BF
- 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
Potential advantages
- people who recently gave up alcohol
* for chronic daily drinkers
Potential disadvantages
- people still drinking while starting acamprosate
* Binge drinkers
Primary target symptom
*Alcohol dependence
Of note
- 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
