Debates surrounding the efficacy of oral naltrexone and acamprosate in treating alcohol use disorders often center on their overall effectiveness compared to a placebo or to each other. However, the reality may be more complex. In treatment for alcohol use disorders, acamprosate has been found to be slightly more efficacious in promoting abstinence, while naltrexone is slightly more efficacious in reducing heavy drinking and craving. This article explores the role of Campral (acamprosate) in managing alcohol use disorder (AUD) and its potential impact on weight loss.
Introduction to Campral and Alcohol Use Disorder
Alcohol dependence has been described as a chronic, relapsing disorder. The harmful use of alcohol is a global public health problem, with nearly 2.5 million deaths per year attributed to alcohol worldwide. Fewer than 15% of individuals with a lifetime diagnosis of alcohol abuse or dependence have ever received treatment for alcohol dependence.
Campral, the brand name for acamprosate, is a medication used to help manage alcohol use disorder (AUD). It works by stabilizing the brain during alcohol withdrawal. When someone with alcohol abuse disorder stops drinking alcohol, the brain will immediately go into withdrawal. Campral can interrupt that function and minimize withdrawal symptoms for the user. It is not a cure for alcoholism, but rather will help you maintain abstinence. This medicine is available only with your doctor's prescription.
How Campral Works
Acamprosate, or N-acetyl homotaurine, is an N-methyl-D-aspartate receptor modulator approved by the Food and Drug Administration (FDA) as a pharmacological treatment for alcohol dependence. The exact mechanism of action of acamprosate is still under investigation, but the drug appears to work by promoting a balance between the excitatory and inhibitory neurotransmitters, glutamate and gamma-aminobutyric acid, respectively.
Acamprosate appears to act as a partial coagonist of NMDA receptors, depending on its concentration and the activity of the NMDA receptor, where at low concentrations acamprosate increases low receptor activity and at high concentrations inhibits highly activated NMDA receptors. Upon further examination, acamprosate may be responsible for regulating NMDA subunit synthesis, indicating an important role in amending the changes caused by chronic alcohol consumption rather than acutely antagonizing NMDA-mediated glutamatergic neurotransmission. Thus, acamprosate helps balance disrupted neurotransmission, mainly by decreasing the overexcitation caused by alcohol dependence.
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The medication aims to reduce cravings and stabilize chemicals in the brain that are disrupted by alcohol withdrawal. Campral helps users control their cravings and makes it easier for them to avoid relapsing.
Campral vs. Other Medications for AUD
Currently, there are three medications for the treatment of alcohol dependence that have been approved by the US Food and Drug Administration (FDA), i.e., disulfiram, naltrexone, and acamprosate.
Naltrexone is a “highly selective” opioid antagonist thought to block endogenous opioids triggered by alcohol. Although the mechanism is not completely understood, naltrexone may work by decreasing dopaminergic activity. Naltrexone is therefore hypothesized to reduce craving and help prevent relapse to heavy drinking by reducing the rewarding effects of alcohol if drinking does occur.
Acamprosate is thought to modulate the glutamate system and promote abstinence by “resetting” the balance between the GABA and glutamate systems that is disrupted in alcohol use disorders. Because of these properties, it is believed to be ineffective if the patient starts drinking again. Although it is sometimes called an anti-craving medication, its impact on craving tends to be mixed.
Unlike disulfiram, which relies on aversion, naltrexone directly targets the learned association of experiencing euphoria following alcohol use.
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The Link Between Campral and Weight Loss
Weight gain is frequently reported as a side effect of acamprosate by people taking this medication to control alcohol cravings associated with alcohol use disorder.
Campral will not reduce or minimize most withdrawal symptoms. However, there are some side effects of Campral that can be worse if the dosage is exceeded.
Side Effects of Campral
There are some side effects to using Campral. There are a number of mild to moderate side effects that can affect those taking Campral. If you have just begun this medication, you can expect to feel some nausea, dizziness, fatigue, vomiting, gas, stomach pains, weight loss, muscle pain, loss of appetite and constipation. Side effects should be mild to moderate and should slowly improve with time. If your side effects worsen, you should consult your doctor or pharmacist immediately.
In some rare cases, patients on Campral may also develop suicidal thoughts or depression. Rarely, users may experience extreme side effects like black stools, vomit that resembles coffee grounds and even seizures. If you experience any of these severe symptoms, head to your local ER as soon as possible. Your dosage may be too high or the drug itself may not be the right choice for you.
Factors Influencing Campral's Efficacy
Controversy exists regarding whether patients starting naltrexone treatment need to be abstinent. Naltrexone is thought to be helpful in reducing the rewarding effect of a first drink and to “diminish the strength of triggers”. However, more recent work has found that patients taking naltrexone benefit from beginning the medication while abstinent.
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In contrast, there is substantial consensus that acamprosate is more effective when patients have been detoxified and are not currently drinking in the days leading up to medication initiation. The biological mechanisms of acamprosate are thought to reduce potential subsequent drinking in the “absence of alcohol”.
Compliance with medication plays an important role in the efficacy of acamprosate. One recent meta-analysis of individual patient data (n = 2305) from 11 randomized controlled trials comparing acamprosate with placebo found that those individuals who took at least 80% of their prescribed medication during the early phases of treatment were five times more likely to complete treatment and had a significantly higher percentage of abstinence days than those individuals who were not compliant.
Genetic factors may also play a role in the patient response to acamprosate.
Safety and Tolerability of Campral
Acamprosate has been described as having an “excellent safety profile”. Perhaps most important for the treatment of alcohol dependence, acamprosate is not metabolized by liver enzymes and alcohol has no effect on the pharmacokinetics of acamprosate.
A systematic review of the published literature from 1990 to 2002 found that patients who received acamprosate generally reported few adverse effects and also reported fewer adverse effects than those patients who received naltrexone. In the Cochrane review, only diarrhea was reported significantly more often for acamprosate than for placebo, but the dropout rate due to side effects was 35% higher in the acamprosate group than in the placebo group.
Overall, numerous narrative and meta-analytic reviews have concluded that acamprosate is safe and well tolerated by patients with alcohol dependence. Notably, of the three FDA-approved medications for alcohol dependence, acamprosate is the only medication that is not associated with liver toxicity (naltrexone is contraindicated in patients with hepatitis or liver failure) and is also not impacted by alcohol use (disulfiram and alcohol consumption results in significant physical symptoms).
Dosage and Administration
To be eligible for Campral, you must have stopped consuming alcohol already. This can be done with the help of benzodiazepines under the supervision of a doctor.
Adults-Two tablets (666 mg per dose) taken three times daily.Children-Use and dose must be determined by your doctor.
You may take this medicine with or without food.
Precautions and Considerations
Before starting Campral, you will need to wean from alcohol completely. This should be done using benzodiazepine medication and under the supervision of a doctor or pharmacist. You should not make any changes to your dosage of Campral without consulting your doctor or pharmacist first.
This medicine may cause some people to be agitated, irritable or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these unwanted effects, tell your doctor right away.
This medicine may cause some people to become drowsy, dizzy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.
The Importance of a Comprehensive Treatment Program
Using acamprosate as part of a treatment program that includes counseling and support. Continuing acamprosate therapy, even in the event of a relapse.
Alcohol addiction can take over your life, ruin relationships and leave you feeling upset, embarrassed and disappointed in yourself. But there is help out there and you don’t have to do it alone.