Acamprosate Alcohol

Disulfiram (250 mg per day) can be used to promote abstinence from alcohol. Acamprosate and naltrexone can be used to decrease craving for alcohol, but they are not likely to result in complete abstinence from alcohol use. 

GABRB2 Y-Aminobutyric acid (1-2 rs3219151 (C+1412T) Alcohol Acamprosate, naltrexone... 

GATA4 GATA-binding protein 4 rsl 3273672 Alcohol Acamprosate... 

Lovinger DM (2000) Examination of ethanol spermine and acamprosate actions on native and recombinant NMDA receptors. Alcohol Clin Exp Res 24 183A... 

Acamprosate. Acamprosate (calcium acetylhomotaurinate), an amino acid derivative, affects both GABA and excitatory amino acid (i.e., glutamate) neurotransmission (the latter effect most likely being the one that is important for its therapeutic effects in alcoholism). Initially evaluated in a singlecenter trial in France, acamprosate was shown to be twice as effective as placebo in reducing the rate at which alcoholic patients returned to drinking (Lhuin-tre et al. 1985). The safety and efficacy of the medication have been studied most widely in Europe, and three of these studies provided the basis for the recent approval of acamprosate by the FDA for clinical use in the United States. As with naltrexone, there exist a number of meta-analytic studies that provide consistent evidence of the efficacy of the medication in the treatment of alcohol dependence. 

Verheul et al. (2004) pooled data from seven European acamprosate studies in an effort to identify patient-related predictors of response to the medication. Although they examined a number of potential predictors, including patients level of physiological dependence before treatment, family history of alcoholism, age of onset of alcoholism, baseline anxiety symptom severity, baseline craving, and gender, none was shown to interact with acamprosate treatment. These findings led the authors to conclude that, although the effect size for acamprosate was moderate, the medication can be considered potentially effective for all patients with alcohol dependence. 

Summary. Currently, the most promising agents that directly reduce alcohol consumption are the opioid antagonists and acamprosate. Further re-... 

Besson J, Aeby F, Kasas A, et al Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism a controlled study. Alcohol Clin Exp Res 22 373-579, 1998... 

Bouza C, Magro A, Munoz A, et al Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence a systematic review. Addiction 99 811-828, 2004... 

Chick J, Lehert P, Landron F, et al Does acamprosate improve reduction of drinking as well as aiding abstinence J Psychopharmacol 17 397-A02, 2003 Chrostek L, Jelski W, Szmitkowski M, et al Gender-related differences in hepatic activity of alcohol dehydrogenase isoenzymes and aldehyde dehydrogenase in humans. J Clin Lab Anal 17 93-96, 2003... 

Kranzler HR, Van Kirk J Efficacy of naltrexone and acamprosate for alcoholism treatment a meta-analysis. Alcohol Clin Exp Res 23 1335-1341, 2001 Kranzler HR, Babor TF, Lauerman R Problems associated with average alcohol consumption and frequency of intoxication in a medical population. Alcohol Clin Exp Res 14 119-126, 1990... 

Littleton] Acamprosate in alcohol dependence how does it work Addiction 90 1179-1188, 1995... 

Littleton J, Zieglgansberger W Pharmacological mechanisms of naltrexone and acamprosate in the prevention of relapse in alcohol dependence. Am J Addict 12 (suppl 1) S3-S11,2003... 

Mann K, Lehert P, Morgan MY The efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals results of a meta-analysis. Alcohol... 

Mason B, Goodman A Acamprosate new preclinical and clinical research. Presented at the 23rd Annual Scientific Meeting of the Research Society on Alcoholism, Denver, CO, June 24—29, 2000... 

Rubio G, Jimenez-Arriero MA, Ponce G, et al Naltrexone versus acamprosate one year follow-up of alcohol dependence treatment. Alcohol Alcohol 36 419 25,... 

Kranzler HR, Van Kirk J Efficacy of naltrexone and acamprosate for alcoholism treatment a meta-analysis. Alcohol Clin Exp Res 23 1335-1341, 2001... 

Koob GF, Mason BJ, De Witte P, et al Potential neuroprotective effects of acamprosate. Alcohol Clin Exp Res 26 386—592, 2002... 

Higgins ST, Sigmon SC, Wong CJ, et al Community reinforcement therapy for cocaine-dependent outpatients. Arch Gen Psychiatry 60 1043—1052, 2003 Hopkins JS, Garbutt JC, Poole CL, et al Naltrexone and acamprosate meta-analysis of two medical treatments for alcoholism. Presented at the 25th annual meeting of the Research Society on Alcoholism, San Francisco, CA, June 28—July 3, 2002... 

Currently the three FDA-approved medications that are indicated to treat alcohol dependence are disulfiram, naltrexone, and acamprosate. Both disulfiram and acamprosate are indicated in patients who have already achieved initial abstinence. Only naltrexone may be initiated without regard to abstinence status. 

Acamprosate A drug that reduces the craving for alcohol after withdrawal and, therefore, of potential benefit in relapse prevention. 

Tempesta E et al. Acamprosate and relapse prevention in the treatment of alcohol dependence a placebo-controlled study. Alcohol 2000 35(2) 202—209. 

The common side effects of naltrexone are nansea, headache, and dizziness. In addition, naltrexone has the potential for toxic effects on the liver and should not be used in an alcoholic with cirrhosis or other known liver disease. Because it blocks opiate receptors, patients treated with naltrexone are unable to benefit from the analgesic effects of opiates such as codeine or morphine. Naltrexone may increase serum levels of acamprosate in patients taking both medications. 

The obvions qnestion is whether combining naltrexone, acamprosate, and/or disnlfiram is better than either medication alone. To our knowledge, this has not been systematically studied, but it may be a viable alternative in particularly severe cases when other treatment options have failed. The cornerstone of success in the treatment of alcoholism is clearly the behavioral intervention including Alcoholics Anonymons. 

---