Campral (acamprosate) was approved by the Food and Drug Administration (FDA) in 2004 as an adjunctive treatment for individuals who have alcohol use disorder. Campral is one of a handful of medications that have this type of approval and restricted use. The other two medications that are approved for the treatment of alcohol use disorders are Antabuse (disulfiram) and ReVia (naltrexone).
Campral’s Mechanism of Action
There are a number of proposed neurotransmitters that are believed to be affected by Campral; however, the actual mechanism of action by which the medication operates is not fully understood. It is believed to primarily affect the activity of the N-methyl-D-aspirate neurons in the brain (NMDA receptors, a subclass of the excitatory neurotransmitter glutamate) and the gamma-aminobutyric acid receptors (GABA, the primary inhibitory neurotransmitter in the brain). In addition, it may affect the calcium channels in neurons.
All of these neural pathways are involved in the physiological effects associated with alcohol abuse. It is believed that the drug inhibits the functioning of the NMDA receptors and acts in enhancing the effectiveness of the GABA receptors, and this accounts for its mechanism of action. However, the actual mechanism of its neuropharmacology is unknown, and this explanation is speculative at best.
Utility in the Treatment of Alcohol Use Disorders
There are a number of double-blind, placebo-controlled research studies that have indicated that use of Campral is an effective adjunctive medication in the treatment of alcohol use disorders. However, better quality research findings are found in meta-analytic studies investigating its effectiveness. Meta-analysis is a statistical technique that is able to review the results of multiple studies regarding some specific treatment outcome. This means that meta-analysis offers more reliable and therefore a more valid picture of the overall effectiveness of a particular form of treatment then a single study does.
- A 2004 meta-analytic study published in the journal Alcoholism: Clinical and Experimental Research included 17 studies that consisted of over 4,000 participants. The overall abstinence rates at six months following discontinuation of alcohol were significantly higher for participants who were treated with Campral than with placebo. The effects of the medication were significant at three, six, and 12 months following discontinuation. Results indicated a modest but significant effect.
- A 2008 meta-analytic study reported in the Journal of Psychopharmacology included 21 studies using Campral and compared the effectiveness of Campral with naltrexone (ReVia, based on studies looking at this drug’s effectiveness in treating alcohol use disorders). It found that Campral use was associated with significant abstinence compared to placebo; however, it was not associated with reducing the number of drinks an individual would take if they relapsed. ReVia use was associated with increased abstinence and with taking fewer drinks during a relapse.
- A 2013 meta-analytic study reported in the journal Addiction that included 21 studies indicated that Campral was more likely to promote abstinence and that ReVia was more likely to promote reduced drinking in individuals with alcohol use disorders.
- A 2015 meta-analytic study also reported in the journal Addiction compared 22 studies using Campral and 27 studies using ReVia. The use of Campral was associated with significantly higher rates of abstinence compared to placebo. The use of ReVia was also associated with this effect; however, individuals were more likely to drop out due to adverse effects of the drug in the studies using ReVia compared to those using Campral.
The results of these meta-analytic studies suggest that Campral is an effective adjunctive treatment for individuals who are in recovery from alcohol use disorders. However, there are a couple of caveats to this research.
- Campral is designed to be used in conjunction with substance use disorder therapy in the treatment of alcohol use disorders. It is not designed to be a standalone treatment. Research results suggest that it is not effective over the long run without being accompanied by a formal substance use disorder therapy program.
- Motivation appears to be a key moderating variable in all of these types of studies. Individuals who are not motivated and committed to abstinence often have poor results.
- The use of Campral is not recommended until an individual has achieved some level of abstinence. Individuals who take the medication while they are still using alcohol will not experience its potential positive effects.
- Campral does not appear to be efficacious in reducing drinking habits, reducing the perceived effects that one gets when drinking alcohol, or directly addressing any formal withdrawal symptoms associated with abstinence from alcohol, but is only efficacious in maintaining abstinence. This means that it can help to control cravings for alcohol in individuals who are abstinent and not using the substance.
Campral has a relatively benign side effect profile; however, all drugs have side effects.
There are some side effects associated with its use, such as:
- Digestive issues that can include nausea, appetite loss, diarrhea, and flatulence
- Issues with the skin that can include itching or sweating
- Dizziness, dry mouth, insomnia, and increased aches and pains
- Cognitive and emotional issues that can include minor issues with anxiety, depression, and, in some instances, suicidal thoughts (rare)
The medication should not be administered to individuals who have renal impairment. There are some instances of individuals developing allergic reactions to the medication. If this happens, the medication should be immediately discontinued, and the individual should contact their physician.
There is not enough empirical evidence to suggest that the use of Campral is associated with a reduction in cravings or in an increase in abstinence from other substances of abuse, such as opiates, stimulant medications, cannabis, etc. It is only formally approved for individuals who have alcohol use disorders and may have some off-label uses, including tentative use for the treatment of other substance use disorders.
It’s not too late to start over