Medication Reference Card: Alcohol Use Disorder

Acamprosate

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

Dr Basanth Kenchaiah
FRANZCP · Cert. Addiction Psych. · MBBS · DPM · DNB (Psychiatry) Addiction Psychiatrist v1.3 · October 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 (McPheeters 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)