acamprosate calcium: clinical use

Prescribing considerations

• Initiate only after alcohol withdrawal once the patient is abstinent; it does not treat acute withdrawal or prevent alcohol-related harm.
• Use within a programme that includes counselling.
• Evidence in people younger than 18 or older than 65 years is not established in the selected licences.
• Safety and efficacy in severe hepatic insufficiency have not been established.
• Review mood, depression, suicidal ideation and behaviour.

Contraindications and cautions

• Hypersensitivity to acamprosate or an excipient.
• Renal impairment above the serum-creatinine threshold specified by the product.
• Breastfeeding.

Monitoring

• Assess renal function before prescribing and when clinically indicated.
• Monitor alcohol use, treatment engagement and ongoing benefit.
• Monitor depression, suicidal thoughts and behaviour.
• Review persistent diarrhoea, significant rash or suspected hypersensitivity.

Clinical pharmacology

Acamprosate is minimally metabolised, is not protein bound and is eliminated in urine. Absorption is slow, variable and reduced by food; clearance relates to renal function. Its action is thought to involve modulation of glutamatergic and inhibitory neurotransmission.

Formulation and product differences

• Both selected products are coated oral tablets containing acamprosate calcium, but their excipients and tablet markings differ.
• Campral EC is a white, round enteric-coated tablet marked “333”; the generic is a plain white, round gastro-resistant tablet.
• The generic product lists blister and bottle presentations, while Campral EC lists blister packaging.

Gastro-resistant tablet

Route: Oral

Strengths: 333 mg