acamprosate

General

Pronunciation:
a-cam-pro-sate

Trade Name(s)

Campral

Ther. Class.

alcohol abuse therapy adjuncts

Pharm. Class.

gamma aminobutyric acid gaba analogues

Indications

Maintenance of alcohol abstinence; part of a comprehensive alcohol abstinence program.

Action

Interacts with and restores balance to CNS glutamate and GABA neurotransmitter systems.

Therapeutic Effect(s):

Continued alcohol abstinence.

Pharmacokinetics

Absorption: 11% absorbed following oral administration.

Distribution: Unknown.

Metabolism and Excretion: Not metabolized; excreted mainly unchanged in urine.

Half-life: 20–33 hr.

TIME/ACTION PROFILE (plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	3–8 hr	unknown

Contraindication/Precautions

Contraindicated in:

Hypersensitivity
Severe renal impairment.

Use Cautiously in:

Moderate renal impairment (↓ dose)
History of depression or suicide attempt
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

CV: palpitations, peripheral edema, syncope

Derm: rash

EENT: abnormal vision, pharyngitis, rhinitis

GI: abdominal pain, anorexia, constipation, diarrhea, flatulence, nausea, taste perversion, vomiting

GU: ↓ libido, erectile dysfunction

Metabolic: ↑ appetite, weight gain

MS: arthralgia, back pain, myalgia

Neuro: abnormal thinking, anxiety, depression, drowsiness, headache, tremor

Resp: cough, dyspnea

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None reported.

Route/Dosage

PO (Adults): 666 mg 3 times daily. Lower doses may be effective in some patients.

Renal Impairment
PO (Adults): CCr 30–50 mL/min: 333 mg 3 times daily.

Availability (generic available)

Delayed-release tablets: 333 mg

Assessment

Assess for signs/symptoms of alcohol withdrawal at start of therapy. Acamprosate does not eliminate or diminish withdrawal symptoms.

Lab Test Considerations:

May cause anemia, lymphocytosis, thrombocytopenia, hyperglycemia, abnormal liver function tests, ↑ AST, ↑ ALT, hyperuricemia, and hyperbilirubinemia.

Implementation

Treatment with acamprosate should be started as soon as possible after the period of alcohol withdrawal, when the patient has achieved abstinence, and should be continued if the patient relapses.
PO Administer without regard to meals. May be given with meals to ↑ adherence. DNC: Swallow tablets whole; do not crush or chew tablets.

Patient/Family Teaching

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Advise patient to take as directed, even if relapse occurs. Advise patient to discuss any renewed alcohol consumption with health care provider.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
May cause dizziness and changes in vision. Advise patient to avoid driving and other activities requiring alertness until response to medication is known.
Encourage patient to continue active counseling and support. Acamprosate helps maintain abstinence only when used as part of a comprehensive psychosocial treatment program.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes