acamprosate calcium


Pharmacologic class: Gamma-aminobutyric acid (GABA) analogue

Therapeutic class: Detoxification agent

Pregnancy risk category C


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


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


• Hypersensitivity to drug

• Severe renal impairment


Use cautiously in:

• mild to moderate renal impairment

• suicidal ideation or behavior

• elderly patients

• breastfeeding patients

• children.


• 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.

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


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.

acamprosate calcium

(a-cam-pro-sate) ,


(trade name)


Therapeutic: alcohol abuse therapy adjuncts
Pharmacologic: gamma aminobutyric acid gaba analogues
Pregnancy Category: C


Maintenance of alcohol abstinence; part of a comprehensive alcohol abstinence program.


Interacts with and restores balance to CNS glutamate and GABA neurotransmitter systems.

Therapeutic effects

Continued alcohol abstinence.


Absorption: 11% absorbed following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Not metabolized, excreted mainly unchanged in urine.
Half-life: 20–33 hr.

Time/action profile (blood levels)

POunknown3–8 hrunknown


Contraindicated in: Hypersensitivity; CCr ≤30 mL/min.
Use Cautiously in: CCr 30–50 mL/min (dose ↓ necessary); History of depression or suicide attempt; Obstetric: Use only if potential maternal benefit outweighs fetal risk; Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • abnormal thinking
  • anxiety
  • depression
  • drowsiness
  • headache

Ear, Eye, Nose, Throat

  • abnormal vision


  • cough
  • dyspnea
  • pharyngitis
  • rhinitis


  • palpitations
  • peripheral edema
  • syncope
  • vasodilation


  • abdominal pain
  • anorexia
  • constipation
  • diarrhea
  • flatulence
  • ↑ appetite
  • nausea
  • taste perversion
  • vomiting


  • ↓ libido
  • erectile dysfunction


  • rash


  • weight gain


  • arthralgia
  • back pain
  • mylagia


  • tremor


Drug-Drug interaction

None noted.


Oral (Adults) Two 333-mg tablets (666 mg/dose) 3 times daily. Lower doses may be effective in some patients.

Renal Impairment

Oral (Adults) CCr 30–50 mL/min—One 333-mg tablet 3 times daily.

Availability (generic available)

Tablets: 333 mg

Nursing implications

Nursing assessment

  • Assess for signs of alcohol withdrawal at initiation of therapy. Acamprosate does not eliminate or diminish withdrawal symptoms.
  • Lab Test Considerations: May cause anemia, lymphocytosis, thrombocytopenia, hyperglycemia, abnormal liver function tests, ↑ AST, ↑ ALT, hyperuricemia, and bilirubinemia.

Potential Nursing Diagnoses

Ineffective coping (Indications)


  • Treatment with acamprosate should be initiated as soon as possible after the period of alcohol withdrawal, when the patient has achieved abstinence, and should be continued if the patient relapses.
  • Oral: Administer without regard to meals. May be given with meals to increase adherence.

Patient/Family Teaching

  • Instruct patient to take medication as directed, even if relapse occurs. Advise patient to discuss any renewed drinking with health care professional.
  • May cause dizziness and changes in vision. Caution patients to avoid driving and other activities requiring alertness until response to medication is known.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding...
  • Encourage patient to continue active counseling and support. Acamprosate helps maintain abstinence only when used as part of a comprehensive psychosocial treatment program.

Evaluation/Desired Outcomes

  • Continued abstinence from alcohol.


a trademark for acamprosate.
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Worcester, charged with possession of diazepam, continued without a plea or finding and placed on pretrial probation for 3 months, $50 victim witness fee; possession of a firearm with a defaced serial number in a felony, possession of a large capacity firearm, improperly storing a large capacity firearm, two counts of firearm use in a felony, three counts of possession of a firearm without a Firearm ID Card, improperly storing a firearm, possession of chemical mace without a firearm ID card, possession of heroin, possession of cocaine with intent to distribute, possession of campral, cephalexin, suboxone, siclobemezprine, and sertraline, possession of methadone, and drug violation near a school or park, dismissed.