Acamprosate: A Review of Its Use in Alcohol Dependence

Abstract

Acamprosate (Campral(®), Aotal(®), Regtect(®)) is one of a limited number of pharmacological treatment options approved as an adjunct to psychosocial interventions to facilitate the maintenance of abstinence in alcohol-dependent patients. It has been used in Europe, the USA and other countries for many years and was recently approved for this indication in Japan. In several randomized, double-blind, placebo-controlled trials (without active comparators), acamprosate in conjunction with psychosocial therapy for 3-12 months was generally significantly better than placebo plus psychosocial interventions in improving various key outcomes, including the proportion of patients who maintained complete abstinence from alcohol (complete abstinence rate), the mean cumulative abstinence duration, the percentage of alcohol-free days and the median time to first drink. Acamprosate as an adjunct to psychosocial interventions also demonstrated efficacy in some randomized, active-comparator trials of similar duration. Although results were not always consistent across individual trials, overall findings were generally favourable for acamprosate in a recent meta-analysis, which showed that alcohol-consumption outcomes were similarly improved with acamprosate or naltrexone. Acamprosate is generally well tolerated, has a low propensity for drug interactions and may be used without dosage adjustment in patients with mild to moderate hepatic impairment, although dosage adjustments or contraindications are recommended in patients with renal impairment. Thus, the use of acamprosate as an adjunct to psychosocial interventions in alcohol-dependent patients provides modest but potentially valuable improvements in alcohol-consumption outcomes and is generally well tolerated.

Don’t stress about CRF: assessing the translational failures of CRF1antagonists

“…In the alcohol research literature, for example, Shaham and De Wit (2016) noted that other drugs that were effective in animal models of stress-induced reinstatement (e.g., alpha-2 adrenoceptor agonists such as clonidine and lofexidine) translated to showing efficacy against stress-induced drug craving in human laboratory studies (Mantsch et al 2016; Sinha et al 2011). Similarly, acamprosate and the opioid receptor antagonists naltrexone and nalmefene reduce operant oral ethanol self-administration in rats under a variety of conditions (Rassnick et al 1992; Heyser et al 1998; Heyser et al 2003; Sabino et al 2006; Ji et al 2008; Gilpin et al 2008; Walker and Koob 2008) and, analogously, show some efficacy to mitigate alcohol use disorders (see Stevenson et al 2015; Keating 2013; Rösner et al 2010; Plosker 2015; but see Palpacuer et al 2015). Gabapentin reduced both the anxiogenic-like behavior and the increased ethanol self-administration observed in withdrawn, ethanol dependent rats, but not non-dependent rats (Roberto et al 2008; Besheer et al 2016; Watson et al 1997) and was found to improve emotional function and reduce insomnia and alcohol use in abstinent alcoholics (Bonnet et al 2007; Malcolm et al 2007; Brower et al 2008; Myrick et al 2009; Mason et al 2014).…”

Survey of Addiction Specialists’ Use of Medications to Treat Alcohol Use Disorder

“…Three medications are approved by the Food and Drug Administration (FDA) for treating AUD: disulfiram, naltrexone (both oral and long-acting injectable formulations), and acamprosate. There is substantial evidence demonstrating the efficacy and safety of these medications in reducing alcohol consumption (4)(5)(6)(7)(8). Further, several medications (e.g., topiramate, gabapentin, and baclofen) approved in the United States for other indications have been shown to be efficacious in treating AUD (8).…”

“…Since that survey was conducted, progress has been made in many areas. The FDA has approved two new pharmacotherapies for AUD: acamprosate and long-acting injectable naltrexone (5,6). Meta-analyses of several other medications, including topiramate and baclofen, have shown them to be efficacious in treating AUD (8).…”

Review article: pharmacotherapy for alcohol dependence – the why, the what and the wherefore

“…The results of a large number of RCTs and meta‐analyses have shown that treatment with acamprosate, in conjunction with psychosocial support, significantly increases the proportion of alcohol‐dependent patients who remained completely abstinent from alcohol at 6 months. Mann et al ., in a meta‐analysis of 17 RCTs, involving 4087 participants, showed that 36.1% of patients receiving acamprosate achieved this endpoint compared with 23.4% of those receiving placebo; overall the number needed to treat (NNT) to achieve continuous abstinence was 7.8 at 6 months and 7.5 at 12 months …”