acamprosate calcium

acamprosate calcium

Campral

Pharmacologic class: Gamma-aminobutyric acid (GABA) analogue

Therapeutic class: Detoxification agent

Pregnancy risk category C

Action

Unclear. May interact with glutamate and GABA neurotransmitter systems centrally, restoring balance between neuronal excitation and inhibition (which is altered by chronic alcoholism).

Availability

Tablets (enteric-coated): 333 mg

⊘Indications and dosages

➣ To maintain abstinence from alcohol in patients with alcohol dependence who are abstinent when treatment begins

Adults: 2 tablets P.O. t.i.d.

Dosage adjustment

• Moderate renal impairment

Contraindications

• Hypersensitivity to drug
• Severe renal impairment

Precautions

Use cautiously in:
• mild to moderate renal impairment
• suicidal ideation or behavior
• elderly patients
• breastfeeding patients
• children.

Administration

• Give without regard to meals.
• Don't crush or break enteric-coated tablet.
• Know that drug helps maintain alcohol abstinence only when used as part of treatment program that includes counseling and support.

Route	Onset	Peak	Duration
P.O.	Unknown	3-8 hr	Unknown

Adverse reactions

CNS: apathy, confusion, agitation, neurosis, malaise, somnolence, abnormal thinking, vertigo, asthenia, anxiety, depression, dizziness, insomnia, paresthesia, tremor, withdrawal syndrome headache, migraine, abnormal dreams, hallucinations, seizures, suicidal ideation or suicide attempt

CV: chest pain, palpitations, syncope, hypotension, angina pectoris, varicose veins, phlebitis, peripheral edema, orthostatic hypotension, vasodilation, tachycardia, hypertension, myocardial infarction

EENT: abnormal vision, amblyopia, hearing loss, tinnitus, rhinitis, pharyngitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, belching, gastroenteritis, gastritis, esophagitis, hematemesis, dry mouth, anorexia, pancreatitis, rectal hemorrhage, GI hemorrhage

GU: urinary frequency, urinary tract infection, urinary incontinence, erectile dysfunction, increased or decreased libido, metrorrhagia, vaginitis

Hematologic: anemia, ecchymosis, eosinophilia, lymphocytosis, thrombocytopenia

Hepatic: hepatic cirrhosis

Metabolic: hyperglycemia, diabetes mellitus, hyperuricemia, gout, avitaminosis

Musculoskeletal: joint, muscle, neck, or back pain

Respiratory: cough, dyspnea, bronchitis, epistaxis, pneumonia, asthma

Skin: pruritus, sweating

Other: abnormal taste, increased thirst, increased appetite, weight gain or loss, pain, infection, flulike symptoms, chills, abscess, hernia, allergic reaction, accidental or intentional injury, intentional overdose

Interactions

Drug-drug. Naltrexone: increased acamprosate blood level

Drug-diagnostic tests. Bilirubin, eosinophils, lymphocytes: increased levels

Liver function tests: abnormal results

Red blood cells: decreased count

Patient monitoring

☞ Monitor patient for depression or expressed suicidal ideation.
• Monitor creatinine clearance during therapy.

Patient teaching

• Instruct patient to swallow tablet whole, with or without food.
• Advise patient to keep taking drug exactly as prescribed, even if he has a relapse. Encourage him to discuss any renewed alcohol consumption with prescriber.
☞ Instruct patient to contact prescriber immediately if he experiences seizure, chest pain, suicidal thoughts, or symptoms of liver problems (such as unusual tiredness or yellowing of skin or eyes).
• Caution patient to move slowly to a sitting or standing position, to avoid dizziness or light-headedness from a sudden blood pressure decrease.
• Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, vision, coordination, and physical dexterity.
• Instruct female patient to notify prescriber if she becomes or intends to become pregnant or to breastfeed during therapy.
• Inform patient that drug helps maintain abstinence from alcohol only when used as part of treatment program that includes counseling and support.
• Emphasize that drug doesn't eliminate or diminish alcohol withdrawal symptoms.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.