Acamprosate: Patient-Friendly Guide for Australian Patients
Basic Product Information
| International Non-proprietary Name (INN) | Acamprosate |
|---|---|
| Australia Brand Names | Campral®, Campral EC® |
| Anatomical Therapeutic Chemical (ATC) Code | N07BB03 |
| Available Forms and Strengths | Tablets (333 mg) |
| Manufacturers | Merck Serono; generic manufacturers |
| Prescription Status | Prescription Only Medicine (Schedule 4, S4) |
Mechanism of Action
For patients: Acamprosate is a medicine designed to help people who have stopped drinking alcohol stay alcohol-free. It does not cause you to dislike alcohol or prevent intoxication if you do drink. Instead, Acamprosate helps to restore the balance of chemicals in your brain that get disrupted through long-term alcohol use, which can reduce cravings and help prevent relapse.
For specialists: Acamprosate calcium is believed to modulate neuronal hyperexcitability during abstinence by interacting with glutaminergic (NMDA) and GABAergic neurotransmission. It indirectly antagonises NMDA receptors and enhances GABAergic neurotransmission, stabilising the chemical balance altered by chronic alcohol intake.
Pharmacokinetics (How the Medicine Works in Your Body)
- Absorption: After oral administration, acamprosate is poorly absorbed (~11% bioavailability) but is sufficient for its therapeutic effects.
- Distribution: Mainly distributed in extracellular fluid.
- Metabolism: It is not metabolised to any significant extent.
- Elimination: Acamprosate is almost completely excreted unchanged by the kidneys.
- Duration of Action: Acamprosate is usually taken three times daily to maintain its effect; the mean elimination half-life ranges from 15 to 36 hours.
Use in Everyday Life and Best Practices
Acamprosate is most effective when used as part of an overall treatment programme, which can include counselling and support. It is not intended for people who are still drinking alcohol or for treating withdrawal symptoms. To get the best results:
- Start acamprosate once you have stopped drinking.
- Take it regularly, three times each day as your doctor prescribes.
- Use the medicine alongside psychological support or counselling, if offered.
- Do not stop taking the medication suddenly without consulting your doctor.
Typical Adult Dose: Two tablets (666 mg) three times per day, adjusted if your weight is below 60 kg to two tablets in the morning, one at midday, and one in the evening.
English context: Counselling services in Australia may be accessed through your GP or local support groups, such as those affiliated with Alcohol and Drug Information Services (ADIS) or local community health clinics.
Dosing in the Morning vs Evening
- Advantages of regular dosing: Regular dosing at morning, midday, and evening helps maintain stable blood levels, improving effectiveness and minimising cravings.
- Dosing tips: Try to link your dose with regular activities (e.g., breakfast, lunch, dinner) to help you remember.
- Missed doses: If you miss a dose and it is less than 6 hours late, take it as soon as you remember. If it’s more than 6 hours late, skip it—do not double your next dose.
- Evening dosing: Some people find taking the evening dose with dinner helps with stomach tolerance.
Taking with Food or on an Empty Stomach
Acamprosate can be taken with or without food. Taking it with meals may help reduce the risk of stomach upset, which can occasionally occur, especially when you first start the medicine. Typical Australian meals are unlikely to affect the medicine’s absorption or action.
- With food: May help if you experience nausea or diarrhoea.
- Without food: The effect is largely unchanged, so take it in the way that suits you best.
Interaction Warnings
| Substance/Condition | Interaction or Warning |
|---|---|
| Alcohol | Acamprosate is not effective if you continue to drink. It is used after stopping alcohol. |
| Food | No significant interaction; may help manage stomach upset. |
| Other Medicines | Few significant medicine interactions. Use caution with medicines affecting kidney function (e.g., NSAIDs, ACE inhibitors). |
| Kidney Disease | Requires dose adjustment or may not be suitable. Inform your doctor if you have kidney problems. |
| Liver Disease | No dose adjustment generally needed, but always discuss with your doctor. |
| Pregnancy and Breastfeeding | Not generally recommended. Discuss risks and benefits with your doctor. |
Indications
| Indication | Status | Description |
|---|---|---|
| Maintenance of abstinence in alcohol dependence | Official/TGA approved | Used to help maintain abstinence in patients who have stopped drinking |
| Reduction of cravings (off-label in some cases) | Sometimes off-label | May be used to help reduce alcohol cravings, as part of a comprehensive program |
| Other substance use disorders | Experimental | Research ongoing; not routinely recommended |
Dosing According to Clinical Indication
| Population | Indicative Dose | Notes |
|---|---|---|
| Adults (≥60 kg) | 666 mg (2 x 333 mg tablets) three times daily | |
| Adults (<60 kg) | Two tablets in the morning, one tablet at midday, one tablet in the evening (total 1,332 mg/day) | |
| Elderly | Same as adult dose, but monitor kidney function closely | |
| Children and Adolescents | Not recommended | Safety and efficacy not established under 18 years old |
| Impaired Kidney Function | Lower dose or not recommended (contraindicated in severe impairment) | Discuss with your doctor |
Safety Profile/Side Effects
| Side Effect | Frequency | Advice |
|---|---|---|
| Diarrhoea | Common | Usually mild; take with food or consult your doctor if persistent |
| Nausea, abdominal pain | Common | May improve over time; take with food |
| Flatulence (wind), headache | Common | Usually mild and transient |
| Insomnia | Uncommon | Mild in most cases; speak to your doctor if problematic |
| Skin rash, itching | Rare | Stop medicine and see your doctor if severe |
| Severe allergic reaction (swelling, difficulty breathing) | Very rare | Seek immediate medical help |
Guidelines for Proper Use
- Always follow your doctor’s instructions on dosing and regularity.
- Do not drink alcohol while taking acamprosate.
- Keep to the same daily routine; use reminders if needed.
- If you experience severe diarrhoea, persistent vomiting, or allergic symptoms, contact your doctor.
- Regularly attend follow-up appointments with your GP or alcohol service provider.
- Acamprosate does not interact with most foods or non-alcoholic drinks common in the Australian diet.
Alternative Treatment Options
- Naltrexone: Available via prescription, works differently by blocking the reward effects of alcohol. May be better if strong cravings persist, but not suitable in liver impairment. Advantages: once-a-day dosing. Disadvantages: may increase risk of relapse if used while still drinking.
- Disulfiram: Available by prescription, causes unpleasant reaction if alcohol is consumed. Advantages: strong deterrent effect if highly motivated. Disadvantages: not for everyone, many dietary and medication restrictions.
- Psychosocial support: Essential as part of long-term recovery. Includes counselling, group therapy, and intervention services like those offered by ADIS and state-funded programs.
Legal, Registration, and Reimbursement Status in Australia
- Therapeutic Goods Administration (TGA): Acamprosate is an approved medicine in Australia.
- Prescription Requirements: S4 (prescription only); must be prescribed by a medical practitioner.
- Pharmaceutical Benefits Scheme (PBS): Acamprosate is available on the PBS, which means eligible patients can access the medicine at a subsidised cost.
- Notifiable Drugs Register: No special requirements for dispensing beyond standard prescription medicines.
Latest Research and Clinical Guidance (2022–2025)
Acamprosate remains a first-line therapy for maintaining alcohol abstinence according to the Australian National Alcohol Treatment Guidelines (2023) and international expert consensus (e.g., NICE CG115; NIAAA 2024 reports). Recent meta-analyses (e.g., Jonas et al., JAMA 2024; Rösner et al., Cochrane 2023) confirm that acamprosate significantly increases the likelihood of remaining alcohol-free for longer periods, especially when combined with counselling and psychosocial support. Ongoing research examines newer agents, but current evidence supports the safe and effective use of acamprosate in Australian practice.
Availability and Delivery
| Pack Size (tablets) | Approximate PBS Price (2024) | Delivery Time (Major Cities) |
|---|---|---|
| 168 (4 weeks) | $40–$44 (PBS copayment); $250–$300 (private) | Sydney: 1–2 days; Melbourne: 1–2 days; Brisbane: 2–3 days; Perth: 3–4 days |
| 336 (8 weeks) | $80–$85 (PBS copayment); $500–$550 (private) | As above; check local pharmacy delivery policies |
Most major pharmacy chains and online pharmacies can supply acamprosate with a valid prescription. Remote or rural locations may experience slightly longer delivery times.
Frequently Asked Questions (FAQ)
- How long should I take acamprosate?
The recommended course is usually six to twelve months, but your doctor may adjust this based on your progress and support needs. - Can I drink alcohol while taking acamprosate?
No—you should not drink alcohol as acamprosate is designed to support abstinence and does not prevent intoxication. - What should I do if I miss a dose?
Take it as soon as you remember if it’s within six hours of your scheduled time. If longer, skip the missed dose—do not double up. - What if I experience side effects?
Mild diarrhoea or stomach upset is common and often settles. If side effects are persistent or severe, speak to your doctor. - Will acamprosate interact with my other medicines?
It has few significant interactions, but always inform your pharmacist/doctor of all your current medicines, especially for kidney concerns.
References: Australian National Alcohol Treatment Guidelines (2023); NICE CG115 (UK, 2024 update); Jonas DE, Amick HR, Feltner C, et al. (2024) JAMA; Rösner S et al. Cochrane Database Syst Rev (2023); NIAAA Alcohol Treatment Navigator (2024). For more information, consult your healthcare professional or local alcohol and drug service.
