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 (blood levels)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity
• CCr ≤30 mL/min.

Use Cautiously in:

• CCr 30–50 mL/min (dose ↓ necessary)
• 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

CNS: abnormal thinking, anxiety, depression, drowsiness, headache

CV: palpitations, peripheral edema, syncope, vasodilation

Derm: rash

EENT: abnormal vision

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

GU: ↓ libido, erectile dysfunction

Metabolic: weight gain

MS: arthralgia, back pain, myalgia

Neuro: tremor

Resp: cough, dyspnea, pharyngitis, rhinitis

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

Interactions

Drug-Drug

None reported.

Route/Dosage

PO (Adults): Two 333-mg tablets (666 mg/dose) 3 times daily. Lower doses may be effective in some patients.

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

Availability (generic available)

Delayed-release tablets: 333 mg

Assessment

• Assess for signs 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 bilirubinemia.

Potential Diagnoses

• Ineffective coping (Indications) 

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 increase adherence.

Patient/Family Teaching

• Instruct patient to take medication as directed, even if relapse occurs. Advise patient to discuss any renewed drinking with health care professional.
• May cause dizziness and changes in vision. Caution patients to avoid driving and other activities requiring alertness until response to medication is known.
• Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Encourage patient to continue active counseling and support. Acamprosate helps maintain abstinence only when used as part of a comprehensive psychosocial treatment program.

Evaluation/Desired Outcomes

Continued abstinence from alcohol.