How effective is acamprosate in supporting continuous abstinence after detoxification from alcohol?
Compared to placebo, acamprosate added to psychosocial
treatment strategies was shown to significantly reduce the risk
of any drinking (NNT* 9) and to significantly increase the cumulative
abstinence duration, while secondary outcomes (gammaglutamyltransferase,
heavy drinking) did not reach statistical
significance. Diarrhoea was the most frequently reported side
effect with acamprosate. Overall, side effects did not cause
more participants to stop treatment when taking acamprosate
compared to placebo. Even though the sizes of treatment effects
appear to be moderate, they should be valued against the
background of the relapsing nature of alcoholism and the limited
therapeutic options currently available for its treatment. The
effects of acamprosate did not differ in industry-sponsored and
non-profit funded trials. Three trials compared acamprosate and
naltrexone, and did not indicate a superiority of one or the other
drug in effect on return to any drinking, return to heavy drinking
and cumulative abstinence duration.
*NNT = number needed to treat to benefit 1 individual.
Effect sizes reflected the additional benefit of adding acamprosate
to psychosocial treatments rather than its benefit compared
to placebo – a fact which often remained unconsidered in the
interpretation of treatment effects. Treatment duration varied
from 8 weeks to 1 year, with 6 months treatment being most
Alcohol dependence is among the leading health risk factors
in most developed and developing countries. In the year 2004,
3.8% of all global deaths and 4.6% of global disability-adjusted
life-years were attributable to alcohol.¹ The therapeutic success of
psychosocial programmes for relapse prevention is moderate but
could potentially be increased by an adjuvant treatment with the
glutamate antagonist acamprosate.
1. Rehm J et al. Lancet 2009;373:2223–33.