Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility

Department of Psychology, Washington State University Vancouver, Vancouver, WA, USA.
Therapeutics and Clinical Risk Management (Impact Factor: 1.47). 02/2012; 8:45-53. DOI: 10.2147/TCRM.S23184
Source: PubMed

ABSTRACT Acamprosate, or N-acetyl homotaurine, is an N-methyl-D-aspartate receptor modulator approved by the Food and Drug Administration (FDA) as a pharmacological treatment for alcohol dependence. The exact mechanism of action of acamprosate is still under investigation, but the drug appears to work by promoting a balance between the excitatory and inhibitory neurotransmitters, glutamate and gamma-aminobutyric acid, respectively, and it may help individuals with alcohol dependence by reducing withdrawal-associated distress. Acamprosate has low bioavailability, but also has an excellent tolerability and safety profile. In comparison with naltrexone and disulfiram, which are the other FDA-approved treatments for alcohol dependence, acamprosate is unique in that it is not metabolized by the liver and is also not impacted by alcohol use, so can be administered to patients with hepatitis or liver disease (a common comorbid condition among individuals with alcohol dependence) and to patients who continue drinking alcohol. Acamprosate has demonstrated its efficacy in more than 25 placebo-controlled, double-blind trials for individuals with alcohol dependence, and has generally been found to be more efficacious than placebo in significantly reducing the risk of returning to any drinking and increasing the cumulative duration of abstinence. However, acamprosate appears to be no more efficacious than placebo in reducing heavy drinking days. Numerous trials have found that acamprosate is not significantly more efficacious than naltrexone or disulfiram, and the efficacy of acamprosate does not appear to be improved by combining acamprosate with other active medications (eg, naltrexone) or with psychosocial treatment (eg, cognitive-behavioral therapy). In this review, we present the data on acamprosate, including its pharmacology, efficacy, safety, and tolerability in the treatment of alcohol dependence.

Download full-text


Available from: Katie Witkiewitz, Aug 09, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Both alcohol and benzodiazepine dependence (AD, BD) are severe and chronic conditions with devastating physical and mental health effects. The relative scarcity and controversial evidential status of available pharmacological interventions for the treatment of patients' acute withdrawal syndrome and/or relapse prevention call for the clinical investigation of novel safe and efficacious agents. AREAS COVERED: We review published studies of pregabalin as monotherapy in the treatment of AD and BD in more than 450 patients. Available evidence includes four RCTs, two in AD with active comparator drugs (naltrexone, tiapride, and lorazepam) and one placebo-controlled, and one placebo-controlled in BD. We also review other available studies on pregabalin's potential to reduce benzodiazepine consumption, its side effects, especially cognitive, as well as extant reports on its liability for abuse. EXPERT OPINION: Available evidence suggests that monotherapy with pregabalin, within the dosage range of 150 - 600 mg/d, is a promising "novel" option for the safe and efficacious relapse prevention of both AD and BD. However, its efficacy as monotherapy in the acute treatment of AD withdrawal syndrome is still controversial. Clinicians should be cautious in prescribing pregabalin to patients with a history of multiple substance recreational use, and monitor its effects on cognition at dosages above 450 mg/d. Further, well-designed clinical research is still needed for the eventual consolidation of pregabalin's place in the treatment of AD and BD.
    Expert Opinion on Investigational Drugs 05/2012; 21(7):1019-29. DOI:10.1517/13543784.2012.685651 · 5.43 Impact Factor
  • Chapter: Alcoholism
    [Show abstract] [Hide abstract]
    ABSTRACT: Alcohol has been consumed by humans for thousands of years, but its biological effects are complex and poorly understood. Similarly, alcoholism is a common and extremely debilitating condition for which there are no truly effective treatments, in part due to our incomplete understanding of the underlying biology of the condition. This chapter describes current understanding of the biology of alcohol intoxication and alcoholism, with a focus on the neurological and molecular bases for these phenomena. We explain what is known about how alcohol produces intoxication, tolerance and physical dependence, and how these relate to alcoholism. We describe risk factors for the development of alcoholism and how these relate to the acute and chronic effects of alcohol. We also outline the current treatments for alcoholism and some common co-morbid disorders. Key Concepts: Alcoholism, like all addictions, is a disease.Alcoholism is defined by repeated alcohol consumption despite known adverse consequences. The urge to drink is uncontrollable.Alcoholism is distinct from the related phenomena of tolerance to alcohol and withdrawal from chronic alcohol exposure.Alcohol is a weak and nonspecific drug, which acts through multiple molecular mechanisms.There are few treatment options for alcoholism and those available have only limited success.Keywords:ethanol;alcohol;alcoholism;craving;relapse;tolerance;withdrawal;naltrexone;acamprosate;disulfiram
    eLS, 08/2012; , ISBN: 0470016175
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article reviews the spectrum of alcohol use disorders. The pharmacologic properties of ethanol and its metabolism, and the historical, physical, and laboratory elements that may help diagnose an alcohol use disorder are examined. The concepts of motivational interviewing and stages of change are mentioned, along with the American Society of Addiction Medicine patient placement criteria, to determine the best level of treatment for alcoholism. Various therapeutic management options are reviewed, including psychological, pharmacologic, and complementary/alternative choices. This article provides a basic understanding of available tools to diagnose and treat this cunning and baffling brain and multisystem disease.
    Clinics in liver disease 11/2012; 16(4):737-62. DOI:10.1016/j.cld.2012.08.006 · 2.70 Impact Factor
Show more