Treating Alcoholism with Acamprosate

Acamprosate is a drug used to maintain abstinence in alcohol-dependent patients sold under the brand Campral.

Many of the people who take acamprosate experience a significant reduction in their urge to drink alcohol, as well as a reduction in symptoms associated with a form of alcohol withdrawal called post-acute withdrawal syndrome.

Doctors caution that the medication does not work for everyone and prescribe acamprosate (calcium-acetyl homotaurine) to recovering alcoholics who have already stopped drinking.

A study in the Journal of the American Medical Association found that patients who received acamprosate showed a significantly higher abstinence rate compared with patients who received a placebo. Over the two-year study period, researchers found acamprosate to be a safe and effective aid in maintaining abstinence from alcohol.

How Alcohol Affects on the Brain

Alcoholism occurs when a person drinks heavily enough and frequently enough to create long-term changes in the way the brain utilizes naturally occurring chemicals called neurotransmitters. Critical changes occur in the normal production of two specific neurotransmitters called glutamate and GABA (gamma-aminobutyric acid). In a healthy brain, glutamate is released in order to encourage more rapid communication between nerve cells called neurons; scientists refer to this activity as neuron excitation. Conversely, GABA is released to slow communication between the brain’s neurons; scientists refer to this activity as neuron inhibition. In a basic analogy, glutamate acts as the brain’s accelerator, while GABA acts as the brain’s brake. Proper brain function depends on the brain knowing when to apply the accelerator and when to apply the brake.

Over time, the repeated presence of excessive amounts of alcohol will alter the relationship between glutamate production and GABA production inside the brain. Gradually, levels of neuron-exciting glutamate rise, while levels of neuron-calming GABA fall. The result is overstimulation of the brain and an increased urge for alcohol. In its absence, neuron excitability will rise to unsustainable levels and trigger the onset of alcohol withdrawal, which produces such symptoms as anxiety, mental and physical agitation, muscle tremors and general irritability. In some cases, extreme neuron excitation associated with alcohol withdrawal can lead to more serious problems, including fully involved seizures or a potentially fatal condition called delirium tremens.

Recovering alcoholics commonly develop a glutamate-related condition called post-acute withdrawal syndrome. This condition arises after the short-term (acute) effects of alcohol withdrawal have passed. Symptoms of post-acute withdrawal include:

  • drug cravings
  • depression
  • loss of personal motivation
  • sleeping problems
  • heightened emotional sensitivity
  • unusual emotional detachment
  • loss of mental clarity
  • various forms of medically serious anxiety
  • loss of normal memory function
  • loss of the ability to feel pleasure.

Depending on the individual, the effects can linger for months or even longer and seriously impede recovery.

Acamprosate Can Help Reduce Cravings

Acamprosate has been in use in Europe since the 1980s. Sanctioned by the Food and Drug Administration in 2004, acamprosate is the most recent medication approved for the treatment of alcohol dependence in the United States. The only available form of the drug is a timed-release tablet. The dosage varies, although most people receive three 666 mg doses per day. People with kidney problems may receive three reduced doses of 333 mg per day.

According to a study published in 2005 in the journal CNS Drugs, scientists now understand that the medication reduces the brain’s overproduction of glutamate and restores some of the balance between the brain’s glutamate and GABA levels. The overall effect of this restored balance is a reduction in the severity of alcohol cravings and other symptoms associated with post-acute withdrawal syndrome.

Despite its effects on post-acute withdrawal, acamprosate does not prevent the symptoms of acute withdrawal, which occur in the immediate aftermath of drinking cessation. Doctors typically prescribe the medication as soon after acute withdrawal as possible. Preferred candidates for acamprosate show a strong commitment to recovery.

Most often the side effects of this drug are not medically serious. Acamprosate’s side effects can include:

  • dizziness
  • diarrhea
  • itching
  • stomach upset
  • high levels of intestinal gas
  • appetite loss
  • body weakness
  • dry mouth

Some negative side effects are serious, however, and do require medical attention. These include: skin rash and altered nerve sensations (including numbness, tingling, or burning) in the legs, feet, arms or hands). Consult your doctor to find out if acamprosate is right for you.

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