Acamprosate

About Acamprosate

Acamprosate is thought to help restore the brain’s balance of signaling that is disturbed by long, heavy alcohol use, which can make it easier to stay away from drinking. The label approves it for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation, and it is meant to be used as part of a comprehensive management program that includes psychosocial support. It has not been shown to work in people who were not abstinent before starting, and it does not ease withdrawal symptoms. The usual dose is two 333 mg tablets (666 mg) three times a day; a lower dose may work for some people. Treatment starts as soon as possible after withdrawal, once abstinence is reached, and the label says to keep taking it if a relapse happens.

There is no boxed warning. Acamprosate is cleared by the kidneys, so people with moderate kidney impairment (creatinine clearance 30 to 50 mL/min) start at one 333 mg tablet three times a day, and it must not be used by anyone with severe kidney impairment (creatinine clearance of 30 mL/min or less) or by anyone allergic to acamprosate calcium or any ingredient. The label warns that suicidal thoughts and suicide attempts were reported more often with acamprosate than with placebo in clinical studies, so patients, families and caregivers are asked to watch for depression or suicidal thinking and report it to the prescriber right away. Acute kidney failure has been reported in use outside the US after approval. The most common side effect is diarrhea, which was also the side effect that most often led people to stop; others include trouble sleeping, anxiety, weakness, nausea, dizziness and itching. MedlinePlus says to call the doctor right away about burning, tingling or numbness in the hands, arms, feet or legs, or a rash.

What is distinctive is how the medicine fits into recovery. MedlinePlus notes that acamprosate does not cause an unpleasant reaction if someone drinks during treatment, and it advises continuing the tablets and calling the doctor if drinking happens, since the medicine helps only for as long as it is taken. The tablets are enteric coated (delayed release, so they dissolve in the intestine) and are swallowed whole, never split, chewed or crushed. On pregnancy, animal studies showed harm to the developing baby at doses close to the human dose and there are no adequate human studies, so the label says to use it only if the potential benefit justifies the risk. The Campral brand has been discontinued, so prescriptions are filled with generic acamprosate calcium. The DailyMed listing gives no DEA schedule: it is not a controlled substance.

Taking Acamprosate

How to take it

Swallow the tablets whole three times a day, at around the same times each day; do not split, chew or crush them. They can be taken with or without food, and the label suggests taking them with meals if you usually eat three meals a day.

If you miss a dose

Take the missed dose as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue your regular schedule. Do not take a double dose.

Storage

In the original container, tightly closed, at room temperature (20 to 25 degrees C, 68 to 77 degrees F), away from heat and moisture and not in the bathroom, out of reach of children. Do not flush unused tablets; use a medicine take-back program.

Interactions to know about

The label reports that alcohol, disulfiram and diazepam do not change how acamprosate is handled by the body, and that naltrexone raises acamprosate levels without a recommended dose change. Tell the pharmacist about every prescription, nonprescription and herbal product you use.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Acamprosate differs from pharmacy to pharmacy

Acamprosate is an older generic with one strength and one form, made by several companies, so quotes differ mainly with the maker a pharmacy buys from, whether it keeps the tablets on the shelf or orders them in, and whether the drug is on a flat-price generic list. Because there is no brand left on the market, every quote is for an equivalent generic tablet.

The full dose is six tablets a day, so a month’s supply is a large tablet count, and labels list bottles from 30 up to 180 tablets and larger. Pharmacies that stock the bigger bottles may quote differently, and on a shorter fill the dispensing fee is a larger share of the quote.

Ways to pay less for Acamprosate without insurance

• Ask the prescriber to write the generic name, acamprosate calcium delayed-release tablets, so any equivalent maker can be dispensed.
• Once the dose is settled, ask the prescriber whether a ninety-day supply is appropriate, since the six tablets a day add up quickly.
• Compare quotes from more than one pharmacy, and ask whether acamprosate is on a flat-price generic list.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Acamprosate

1. 1.Should I take my tablets with meals, and how should I space my three doses through the day?
2. 2.Do my other medicines, including any antidepressant or naltrexone, affect how acamprosate works for me?
3. 3.Does my kidney function mean I need a lower dose?
4. 4.What should I do if I drink while I am taking this medicine?

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