Medication Reference Card — Alcohol Use Disorder

Acamprosate

Calcium acetyl homotaurinate · 666 mg TDS · PBS listed (AUD — abstinence maintenance)

Dr Basanth Kenchaiah
FRANZCP · MBBS · DPM · DNB (Psychiatry) · Cert. Addiction Psych. Addiction Psychiatrist v1.0 · May 2026

Audience Clinicians

Purpose Prescribing quick-reference for acamprosate in alcohol use disorder (AUD).

Key messages

Normalises glutamate/GABA imbalance in abstinence; reduces protracted withdrawal dysphoria and craving
666 mg TDS (2 tablets three times daily); requires dose adjustment in renal impairment — avoid if CrCl <30
PBS listed; no hepatic metabolism — safe in liver disease; start at or near abstinence for best effect

For Patients

Acamprosate helps reduce the uncomfortable feelings — restlessness, anxiety, and cravings — that can happen after stopping alcohol. It works best for people who want to stay completely alcohol-free. It is safe for the liver and well tolerated.

Particularly useful when comorbid with:

Anxiety disorders (early abstinence) Post-acute withdrawal syndrome (PAWS) Mild–moderate renal impairment (where hepatotoxic agents avoided) Abstinence-focused goal post-detox No significant renal disease

For Clinicians

Mechanism

Modulates NMDA glutamate receptors and GABA-A receptors, reducing the glutamatergic hyperexcitability seen during alcohol abstinence. Does not produce euphoria or cause aversive reactions with alcohol. No hepatic metabolism.

Dosing

Standard: 666 mg (2 tablets) three times daily (1998 mg/day total). CrCl 30–50 mL/min: reduce to 333 mg TDS. CrCl <30 mL/min: contraindicated. Begin after detoxification is complete. Best initiated within days of completing detox.

Evidence

High-quality evidence for maintaining abstinence. JAMA 2023 meta-analysis (Jonas et al.): NNT ≈ 12 for any drinking relapse. Performs best in abstinence-focused patients post-detox. Less effective than naltrexone for harm-reduction goals or active heavy drinking.

Cautions

Renal dose reduction essential — check CrCl before prescribing
Contraindicated if CrCl <30 mL/min
Mild GI side effects common (diarrhoea, nausea) — usually self-limiting
No hepatotoxicity — safe to use with liver disease
No aversive interaction with alcohol (does not deter drinking if relapse occurs)