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Acamprosate: A Review of Its Use in Alcohol Dependence

Abstract

Acamprosate (Campral®, Aotal®, Regtect®) is one of a limited number of pharmacological treatment options approved as an adjunct to psychosocial interventions to facilitate the maintenance of abstinence in alcohol-dependent patients. It has been used in Europe, the USA and other countries for many years and was recently approved for this indication in Japan. In several randomized, double-blind, placebo-controlled trials (without active comparators), acamprosate in conjunction with psychosocial therapy for 3–12 months was generally significantly better than placebo plus psychosocial interventions in improving various key outcomes, including the proportion of patients who maintained complete abstinence from alcohol (complete abstinence rate), the mean cumulative abstinence duration, the percentage of alcohol-free days and the median time to first drink. Acamprosate as an adjunct to psychosocial interventions also demonstrated efficacy in some randomized, active-comparator trials of similar duration. Although results were not always consistent across individual trials, overall findings were generally favourable for acamprosate in a recent meta-analysis, which showed that alcohol-consumption outcomes were similarly improved with acamprosate or naltrexone. Acamprosate is generally well tolerated, has a low propensity for drug interactions and may be used without dosage adjustment in patients with mild to moderate hepatic impairment, although dosage adjustments or contraindications are recommended in patients with renal impairment. Thus, the use of acamprosate as an adjunct to psychosocial interventions in alcohol-dependent patients provides modest but potentially valuable improvements in alcohol-consumption outcomes and is generally well tolerated.

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Disclosure

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on the article. Changes based on any comments received were made by the author on the basis of scientific and editorial merit. Greg Plosker is a salaried employee of Adis/Springer.

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Correspondence to Greg L. Plosker.

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The manuscript was reviewed by: M. Pettorruso, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy; A. Yoshimura, National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan.

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Plosker, G.L. Acamprosate: A Review of Its Use in Alcohol Dependence. Drugs 75, 1255–1268 (2015). https://doi.org/10.1007/s40265-015-0423-9

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Keywords

  • Alcohol Dependence
  • Naltrexone
  • Pathological Gambling
  • Psychosocial Intervention
  • Disulfiram