ACAMPROSATE

brands

Class

• Neuroscience-based Nomenclature: glutamate multimodal (Glu- MM) Alcohol dependence treatment

ACAMPROSATE commonly prescribed for

(Bold for FDA approved)

How ACAMPROSATE works

• Theoretically reduces excitatory glutamate neurotransmission and increases inhibitory gamma-aminobutyric acid (GABA) neurotransmission

• Binds to and blocks certain glutamate receptors, including metabotropic glutamate receptors

• Because withdrawal of alcohol following chronic administration can lead to excessive glutamate activity and deficient GABA activity, acamprosate can act as “artificial alcohol” to mitigate these effects

How long until ACAMPROSATE works

• Has demonstrated efficacy in trials lasting between 13 and 52 weeks

Notable Side Effects

• Diarrhea, nausea

• Anxiety, depression

Life Threatening Side Effects

• Suicidal ideation and behavior (suicidality)

weight gain

unusual

sedation

unusual

What to do about ACAMPROSATE side effects

• Wait

• Adjust dose

• If side effects persist, discontinue use

usual dosage range

• 666 mg three times daily (>60 kg)

• 666 mg two times daily (<60 kg)

Dosage Forms

• Tablet 333 mg and 666mg

long term use

•Has been studied in trials up to 1 year

habit forming

•No

Renal Impairment

• For moderate impairment, recommended dose is 333 mg three times daily

• Contraindicated in severe impairment

Hepatic Impairment

• Dose adjustment not generally necessary

Cardiac Impairment

• Limited data available

Elderly

• Some patients may tolerate lower doses better

• Consider monitoring renal function

Children and Adolescents

• Safety and efficacy have not been established

Pregnancy

• Risk Category C [some animal studies show adverse effects; no controlled studies in humans]

• Pregnant women needing to stop drinking may consider behavioral therapy before pharmacotherapy

• Not generally recommended for use during pregnancy, especially during first trimester

Breast Feeding

• Unknown if acamprosate is secreted in human breast milk, but all psychotropics assumed to be secreted in breast milk

• Recommended either to discontinue drug or bottle feed