Campral (Acamprosate)

Campral (Acamprosate) – Patient-Friendly Medicine Guide for Australia

Basic Product Information

Mechanism of Action

For Patients: Campral (acamprosate) is used to help people who have stopped drinking alcohol stay alcohol-free. It works by balancing certain chemicals in your brain that are disrupted by chronic alcohol use. This helps reduce cravings for alcohol and supports recovery.

For Specialists: Acamprosate is thought to modulate glutamatergic neurotransmission and restore the disrupted balance between neuronal excitation (glutamate) and inhibition (gamma-aminobutyric acid, GABA) due to chronic alcohol exposure. It does not have anxiolytic, antidepressant, or hypnotic properties.

Pharmacokinetics

• Absorption: Moderate oral bioavailability (approx. 11%). Food decreases bioavailability but is not clinically significant.
• Distribution: Distributed mainly in extracellular fluid. Does not cross the blood-brain barrier in significant amounts.
• Metabolism: Not significantly metabolised by the liver. Excreted unchanged by the kidneys.
• Elimination: Renal excretion. Mean elimination half-life is 20–33 hours.
• Duration of Action: Requires regular dosing to maintain effective brain levels.

Using Campral in Everyday Life

Campral is used as part of a complete alcohol dependence treatment program, alongside counselling and support. It does not help with withdrawal symptoms but helps reduce relapse risk once you have stopped drinking.

• Typical Adult Dose: 666mg (two tablets) three times a day, preferably morning, midday, and evening. Total daily dose: 1998mg.
• How to Use: Swallow tablets whole with a glass of water. Do not chew or crush. Try to take doses at approximately the same times daily.
• Duration: Usually prescribed for 1–6 months, depending on progress and doctor’s advice.

In Australia, Campral is often started as soon as possible after alcohol withdrawal. Ongoing recovery support is advised, such as Alcohol & Drug Information Service (ADIS), counselling, or local support groups (e.g., SMART Recovery, AA, or LifeRing).

Dosing: Morning vs Evening

• Campral should be taken 3 times a day. Spreading doses helps maintain steady levels.
• Taking at regular times (e.g., 8am, 2pm, and 8pm) helps form a routine and reduces the risk of missed doses.
• Taking all tablets in one dose is not recommended. Morning and midday dosing avoid sleep disruption and enhance daytime coverage.
• If a dose is missed, take it as soon as you remember unless it is almost time for the next dose.

Taking Campral With Food or on an Empty Stomach

• Campral can be taken with or without food. Swallow with water.
• Food may slightly decrease absorption but does not significantly affect effectiveness. For those with sensitive stomachs, taking after food may help avoid gastrointestinal upset.
• No specific interaction with popular Australian foods (e.g., bread, cereals, fruit, vegetables, typical protein sources).

Interaction Warnings

Indications

Dosing According to Clinical Indications

Safety Profile and Side Effects

• Common Side Effects (>1/100):
  • Digestive: Diarrhoea, nausea, stomach pain, flatulence.
  • General: Headache, fatigue, sleep disturbances, itching, muscle or back pain.
• Rare Side Effects (<1/1,000):
  • Allergic reactions (rash, swelling, difficulty breathing)
  • Changes in mood (depression, anxiety)
  • Liver function changes (rare, monitoring advised)
• Warnings:
  • Not for use in severe kidney (renal) impairment—contraindicated if creatinine clearance <30mL/min.
  • Caution in pregnancy or breastfeeding—not generally recommended except on specialist advice.
  • No evidence of dependence, withdrawal, or misuse with Campral.

Guidelines for Proper Use (Pharmacist and Clinic Advice)

• Begin Campral only after you have stopped drinking alcohol. It will not treat withdrawal symptoms.
• Take every dose as prescribed, even if you feel well. Missing doses can make relapse more likely.
• If you forget a dose, take it as soon as you remember. If it's almost time for your next dose, skip the missed dose—do not double up.
• Regular reviews with your doctor or support team are important. Discuss any side effects or challenges.
• Dietary restrictions are not necessary; maintain a balanced, healthy diet commonly recommended in Australia.
• Let your pharmacist know if you are taking any other regular prescriptions, over-the-counter medicines, or supplements.
• Look after your mental health—access local support and resources if needed (see Australian Alcohol Helplines for support).

Alternative Treatment Options

• Naltrexone (Revia, generic):
  • Opioid antagonist that reduces the rewarding effects and cravings for alcohol.
  • Pros: Can be started earlier (with recent drinking), oral daily dosing.
  • Cons: Not suitable for opioid users, risk of hepatotoxicity, can cause nausea.
• Disulfiram (Antabuse):
  • Discourages drinking by causing unpleasant reactions with alcohol.
  • Pros: Highly effective deterrent if supervised.
  • Cons: Must avoid all forms of alcohol, risk of serious reactions, daily supervision may be needed.
• Psychological Support:
  • Cognitive behaviour therapy (CBT), motivational interviewing, and peer support are essential for effective recovery.
  • Pharmacotherapy is most effective when combined with ongoing support and non-drug therapies.
• Other:
  • Some GPs may prescribe topiramate or baclofen off-label; not first-line as per current Australian guidelines.

Legal, Registration, and Reimbursement Status in Australia

• Legal Status: Schedule 4 (Prescription Only Medicine).
• TGA Registration: Registered and approved by the Therapeutic Goods Administration.
• PBS (Pharmaceutical Benefits Scheme): Campral is listed for alcohol dependence under certain clinical criteria, which means eligible patients can access subsidised pricing.
• Prescription must be from a medical practitioner. Repeat prescriptions are allowed according to standard guidelines.
• Campral is NOT classified as a controlled or addictive medicine.

Latest Research and Clinical Guidelines (2022–2025)

• Recent NICE (UK, 2022) and NHMRC (Australia, 2023) guidelines confirm Campral’s role as a first-line option for maintaining abstinence in alcohol dependence after detoxification.
• Meta-analyses (Cochrane, 2022) show Campral reduces relapse risk by about 12% compared to placebo when combined with counselling.
• Australian Society for Mental Health (ASMHS, 2024) recommends Campral as suitable for most patients, especially those with liver issues (as it is not metabolised by the liver).
• No significant new safety concerns reported; known advice remains valid (NHMRC, 2024).

Availability and Delivery

Frequently Asked Questions (FAQ)

• How long should I take Campral?
  Most people take Campral for at least 3–6 months, but your doctor will recommend the best duration for your needs. Some may need longer treatment depending on risks and ongoing support.
• Can I drink alcohol while taking Campral?
  Campral is designed to help you remain alcohol-free. Drinking alcohol reduces its effectiveness and is not recommended during treatment.
• What should I do if I miss a dose?
  Take the missed dose as soon as you remember—unless it’s nearly time for your next dose. Never double up doses.
• Is Campral safe if I have liver problems?
  Yes, Campral does not depend on the liver for metabolism. However, severe kidney impairment is a contraindication.
• Can I drive or work while on Campral?
  Side effects are generally mild. If you feel dizzy or drowsy, avoid driving or operating machinery until you are sure it is safe for you.