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Anti-craving Agent — Alcohol Relapse Prevention (GABA/Glutamate Modulator) Pregnancy: Avoid — insufficient safety data. Alcohol abstinence is the primary goal in pregnancy; psychosocial support preferred over pharmacotherapy.

Acamprosate Calcium

Brand names: Campral EC

Adult dose

Dose: >60kg: 666mg (2 tablets) TDS. ≤60kg: 666mg BD (morning) + 333mg BD (midday and evening) = 1332mg daily. Start as soon as abstinence achieved; continue for 1 year.
Route: Oral (enteric-coated tablet — swallow whole)
Frequency: Three times daily
Max: 1998mg daily (>60kg)
Mechanism: believed to modulate GABA and glutamate neurotransmission, reducing alcohol craving and post-abstinence hyperexcitability. Does not cause aversion reaction (unlike disulfiram). Can be used if patient relapses — restart after re-establishing abstinence. No interaction with alcohol (unlike disulfiram). Best evidence when combined with psychosocial support.

Paediatric dose

Route: Oral
Frequency: Three times daily
Max: Not applicable
Not licensed under 18 years. Seek specialist addiction psychiatry opinion.

Dose adjustments

Renal

eGFR 30–60: reduce dose to 333mg TDS. eGFR <30: contraindicated — renally excreted.

Hepatic

No dose adjustment required — not hepatically metabolised. Safe in hepatic impairment (advantage over naltrexone in alcoholic liver disease).

Clinical pearls

  • NICE CG115: acamprosate and naltrexone are both recommended for relapse prevention in alcohol dependence — choice depends on patient preference and comorbidities; acamprosate preferred if liver disease present (renally excreted; naltrexone is hepatotoxic)
  • Key advantage over disulfiram: acamprosate can be continued if the patient has a slip — does not cause a reaction with alcohol; does not require supervised consumption
  • Continue for 1 year: evidence shows benefit across 12 months of treatment — stopping earlier loses relapse prevention benefit
  • Diarrhoea is very common (up to 30%) — counsel at initiation; usually improves after first 2 weeks; if severe, dose reduction or stopping may be needed

Contraindications

  • eGFR <30
  • Hypersensitivity to acamprosate

Side effects

  • Diarrhoea (very common)
  • Nausea
  • Abdominal pain
  • Pruritus
  • Rash
  • Headache
  • Rarely: depression or suicidal ideation (monitor)

Interactions

  • No significant pharmacokinetic drug interactions
  • Alcohol: acamprosate does not cause a reaction with alcohol — if patient relapses, acamprosate can be continued and abstinence re-established

Monitoring

  • Alcohol use (urine biomarkers, breathalyser, self-report)
  • eGFR (before starting and periodically)
  • Mood and suicidality (screening)
  • GI symptoms (diarrhoea management)

Reference: BNFc; BNF 90; NICE CG115 (Alcohol Dependence); NICE NG115. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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