Acamprosate
Campral
NMDA/GABA ModulatorGeneric availableTDM data
The mechanism of action of acamprosate in maintenance of alcohol abstinence is not completely understood. Chronic alcohol exposure is hypothesized to alter the normal balance between neuronal excitation and inhibition. In vitro and in vivo studies in animals have provided evidence to suggest acamprosate may interact with glutamate and GABA neurotransmitter systems centrally, and has led to the hypothesis that acamprosate restores this balance.
Compare Acamprosate →FDA-Approved Indications
- Maintenance of alcohol abstinence (alcohol dependence; abstinent at start; adults)
Common Off-Label Uses
- Tinnitus (investigational)
- Anxiety in alcohol recovery
What Sets This Drug Apart
- GABA/glutamate modulator (exact mechanism unclear) for alcohol use disorder relapse prevention; reduces craving rather than blocking alcohol effects
- Entirely renally excreted with zero hepatic metabolism — safe in alcoholic liver disease (unlike naltrexone, which has hepatotoxicity risk)
- Contraindicated in severe renal impairment (CrCl <30 mL/min); dose reduction in moderate impairment
- TID dosing (666 mg three times daily) is a significant adherence burden; no long-acting formulation available
- No abuse potential and no interaction with alcohol itself — can be started while patient is still drinking (though abstinence is preferred)