Drug reference

Acamprosate

Anti-craving agent for alcohol use disorder (NMDA modulator) · Agent for alcohol dependence

Also known as Acamprosate calcium, Campral EC

START

>60 kg: 666 mg PO three times daily (after detox)

TYPICAL MAX

1998 mg/day (666 mg TID)

STOP IF

Suicidal ideation / severe hypersensitivity

WATCH

Mood / suicidality, adherence; renal function (CrCl-banded dosing)

CDSCO approvedATC N07BB03

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 2h · absorption
PEAK: 5h · Tmax
t½: 1d · t½
DURATION: 8h · TID

EXCRETION

Renal — essentially unchanged

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Use only if clearly needed; limited data.

FDA category + note

Mechanism

Structural analogue of GABA / taurine that modulates glutamate (NMDA) receptor activity, restoring the glutamate–GABA balance disrupted by chronic alcohol exposure; reduces protracted abstinence-related craving and relapse rate.

Indications

Maintenance of abstinence from alcohol after detoxification, as part of a comprehensive psychosocial programme

Dosing

Adult: >60 kg: 666 mg PO three times daily. ≤60 kg: 666 mg morning, 333 mg midday, 333 mg evening.
Pediatric: Not established.
Renal adjustment: CrCl 30–50: 333 mg three times daily. CrCl <30: contraindicated.
Hepatic adjustment: No adjustment (not hepatically metabolised — safe in cirrhosis).
Geriatric: No specific adjustment beyond renal function.
Max dose: 1998 mg/day (666 mg three times daily)

Pharmacokinetics

Onset

Anti-craving effect over weeks; durable with adherence

Peak effect

~3–8 h (Tmax)

Duration

~8 h (three-times-daily dosing)

Half-life

~20–33 h

Bioavailability

~11% (poor oral absorption)

Protein binding

Negligible

Metabolism

Not metabolised (excreted unchanged)

Excretion

Renal (essentially unchanged)

Contraindications

Severe renal impairment (CrCl <30)
Hypersensitivity
Caution: significant hepatic impairment is NOT a contraindication (no hepatic metabolism)

Side effects

Common

DiarrhoeaNauseaFlatulencePruritusHeadacheInsomnia

Serious

Suicidal ideation (boxed-style concern)
Severe hypersensitivity / SJS (rare)
Acute kidney injury (rare)

Pregnancy & lactation

Pregnancy

Use only if clearly needed; limited data.

Lactation

Limited data; weigh benefit/risk.

Drug interactions

Alcohol

Moderate

Database

No disulfiram-like reaction; alcohol still impairs recovery

Counsel; reaffirm abstinence