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[Pharmacology](https://durgical.com/en/pharmacology/) · [Medicines for alcohol use disorder](https://durgical.com/en/pharmacology/classes/medicines-for-alcohol-use-disorder/)

# Acamprosate

A medicine that helps people who have stopped drinking stay abstinent. It is not metabolised and leaves through the kidneys, so it suits liver disease.

Updated 2026-11-01

- Class: [Medicines for alcohol use disorder](https://durgical.com/en/pharmacology/classes/medicines-for-alcohol-use-disorder/)
- Target: Glutamate and GABA systems (mechanism not fully known)
- ATC code: N07BB03
- WHO Model List of Essential Medicines

## Mechanism of action

Long-term drinking leaves the brain with too much glutamate excitation and too little GABA inhibition once alcohol stops, which feeds craving. Acamprosate (N-acetylhomotaurine) is thought to rebalance these two systems; its exact mechanism is not known.

- After stopping alcohol, glutamate excitation runs high
- Acamprosate helps rebalance glutamate and GABA
- Craving falls and abstinence is easier to keep

## Pharmacokinetics

**Absorption**
Low bioavailability by mouth, about 11%

**Metabolism**
Not metabolised

**Elimination**
Unchanged through the kidneys

**Half-life**
About 20 to 33 hours (terminal)

## Indications

- Keeping abstinence in alcohol dependence, in people already abstinent, with psychosocial support [Alcohol use disorder →](https://durgical.com/en/conditions/alcohol-use-disorder/)

## Adverse effects

### Common

- Diarrhoea (the most frequent)
- Insomnia and weakness
- Itching, nausea and flatulence

### Serious (rare, important)

- Depression and suicidal thoughts

## Contraindications

- Severe kidney impairment
- Hypersensitivity to acamprosate

## Key interactions

**Naltrexone**
Modestly higher acamprosate levels; not clinically important

**Alcohol, disulfiram, diazepam**
Do not change acamprosate kinetics

## What is monitored

- Kidney function (creatinine clearance) before and during treatment
- Mood and suicidal thoughts
- Drinking and relapse

## Administration and safety

- Given by mouth as delayed-release tablets, with or without food
- Started after alcohol withdrawal is over, as part of a support programme
- Continued even if a relapse occurs

## Nursing care

- Check kidney function before the first dose
- Ask about mood and thoughts of self-harm at each visit
- Teach that it does not stop withdrawal symptoms or cause a reaction with alcohol
- Encourage counselling or support groups

## Pregnancy and breastfeeding

Used in pregnancy only if the benefit justifies the risk; animal studies showed malformations.

## Memory aid

Acamprosate: «A CALM-prosate for the craving brain» – kidneys out, liver safe, start once sober.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is acamprosate a good option in alcoholic liver disease?

It is not metabolised by the liver and is excreted unchanged in the urine.

## When is acamprosate started?

Once the person is abstinent; it does not relieve withdrawal.

## What is the most frequent adverse effect of acamprosate?

Diarrhoea.

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## Related drugs

- [Disulfiram](https://durgical.com/en/pharmacology/disulfiram/)
- [Naltrexone](https://durgical.com/en/pharmacology/naltrexone/)

## Related conditions

- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)

[← Back to the class: Medicines for alcohol use disorder](https://durgical.com/en/pharmacology/classes/medicines-for-alcohol-use-disorder/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - ACAMPROSATE CALCIUM tablet, delayed release](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=43e9ef60-2d85-4394-906b-93042fea099a) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 27 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N07BB03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/acamprosate/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/acamprosate/