Campral

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Campral on Prescriptsy

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Campral EC contains acamprosate calcium, a medicine licensed in the United Kingdom for the maintenance of abstinence in alcohol-dependent patients who have completed detoxification.

Alcohol dependence is a chronic relapsing condition that affects an estimated 600,000 people in England alone, with alcohol-related hospital admissions exceeding 350,000 per year.

Campral works by stabilising the neurochemical imbalance that develops in the brain during chronic alcohol exposure, reducing cravings and the neurological drive to resume drinking.

Campral is not a cure for alcohol dependence, nor does it treat alcohol withdrawal.

It is used as part of a comprehensive treatment programme that includes psychological support, structured counselling, and lifestyle change.

This page provides a detailed clinical overview of how Campral works, correct dosing, expected outcomes, side effects, safety warnings, and how to access treatment in the UK.

Important safety information about Campral

Before reading further, note the following key safety points about Campral.

• Campral must only be started after alcohol detoxification is complete. It does not treat or prevent alcohol withdrawal symptoms, which can be life-threatening.
• Campral is contraindicated in patients with severe renal impairment (serum creatinine greater than 120 micromol/L).
• If you experience significant mood changes, suicidal thoughts, or worsening depression while taking Campral, seek medical help immediately.
• Continue taking Campral even if you have a lapse and drink. Discuss any lapse with your alcohol treatment team.

Understanding alcohol dependence

Alcohol dependence is a complex medical condition characterised by a strong compulsion to drink, difficulty controlling the amount consumed, tolerance (needing more alcohol to achieve the same effect), and physical withdrawal symptoms when alcohol intake is reduced or stopped.

It develops through the repeated interaction of alcohol with brain reward pathways and neurotransmitter systems, particularly those involving GABA (gamma-aminobutyric acid), glutamate, dopamine, and endogenous opioids.

The World Health Organisation classifies alcohol use disorder as a disease, and the Royal College of Physicians emphasises that it should be managed with the same evidence-based approach as any other chronic medical condition.

In the UK, the Chief Medical Officers' low-risk drinking guidelines recommend no more than 14 units of alcohol per week for both men and women, spread over three or more days with several alcohol-free days each week.

Alcohol dependence causes substantial harm to physical health (liver disease, pancreatitis, cardiomyopathy, neuropathy, increased cancer risk), mental health (depression, anxiety, psychosis, cognitive impairment), and social functioning (relationship breakdown, unemployment, financial difficulty, criminal justice involvement).

Treatment is effective and significantly reduces morbidity and mortality.

How Campral works: mechanism of action

Chronic alcohol consumption produces neuroadaptive changes in the brain.

Alcohol enhances the inhibitory effects of GABA at GABA-A receptors and suppresses the excitatory activity of glutamate at NMDA (N-methyl-D-aspartate) receptors.

Over time, the brain compensates by downregulating GABA-A receptors and upregulating NMDA receptors to maintain functional equilibrium in the presence of alcohol.

When alcohol is abruptly removed, this compensatory neuroadaptation is unmasked: GABA-mediated inhibition is reduced and glutamate-mediated excitation is increased, producing a state of central nervous system hyperexcitability.

This hyperexcitable state underlies the symptoms of acute alcohol withdrawal (tremor, anxiety, seizures, delirium tremens) and, at a subtler level, the protracted dysphoria, insomnia, restlessness, and craving that persist for weeks to months after detoxification and drive relapse.

Acamprosate partially restores the balance between excitatory and inhibitory neurotransmission.

It acts as a partial co-agonist at the NMDA receptor (modulating rather than fully blocking glutamate activity) and enhances GABA-A receptor function.

The net effect is a reduction in the hyperexcitable state that drives craving and relapse. Unlike benzodiazepines, acamprosate does not cause sedation, cognitive impairment, or physical dependence.

Unlike disulfiram, it does not produce an adverse reaction when alcohol is consumed.

Clinical evidence and NICE guidance

The efficacy of acamprosate has been established in over 20 randomised controlled trials involving more than 6,000 patients.

A Cochrane meta-analysis (2010) of 24 trials found that acamprosate significantly reduced the risk of any drinking (relative risk 0.86, 95% confidence interval 0.81 to 0.91) and increased cumulative abstinence duration compared with placebo.

The number needed to treat (NNT) to prevent one person from returning to any drinking was 9.

NICE Clinical Guideline CG115 (Alcohol-use disorders: diagnosis, assessment, and management of harmful drinking and alcohol dependence) recommends acamprosate as a first-line pharmacological option for relapse prevention after successful detoxification.

It should be offered alongside an evidence-based psychosocial intervention such as cognitive behavioural therapy (CBT), behavioural couples therapy, or a structured mutual support programme.

Naltrexone is recommended as an alternative for patients who cannot take acamprosate or who prefer a different treatment approach.

The COMBINE study (2006), a large US multicentre trial, found that acamprosate did not demonstrate a significant benefit over placebo in its primary analysis when combined with a medical management intervention.

However, subsequent European studies and meta-analyses have consistently supported the efficacy of acamprosate, and its use remains recommended by NICE, the World Health Organisation, and the European Medicines Agency.

Dosage and administration

Campral EC is supplied as enteric-coated tablets, each containing 333 mg of acamprosate calcium. The enteric coating protects the active ingredient from degradation by gastric acid.

Tablets must be swallowed whole with water and should not be crushed, chewed, or dissolved.

The recommended dose for adults weighing 60 kg or more is two tablets three times daily (morning, midday, and evening), giving a total daily dose of 1,998 mg.

For adults weighing less than 60 kg, the recommended dose is two tablets in the morning, one at midday, and one in the evening (total 1,332 mg daily).

Treatment should begin as soon as possible after detoxification and abstinence have been achieved. The recommended duration is 12 months.

If a patient relapses and drinks during treatment, Campral should be continued, as acamprosate has no interaction with alcohol and its benefits accrue over the full course of treatment.

The decision to discontinue Campral prematurely should be made collaboratively between the patient, prescriber, and alcohol treatment team.

Special populations

No dose adjustment is required for patients with hepatic impairment, as acamprosate is not metabolised by the liver and is excreted unchanged by the kidneys.

Campral is contraindicated in severe renal impairment (serum creatinine greater than 120 micromol/L).

In mild to moderate renal impairment, dose reduction may be considered and renal function should be monitored.

Campral is not recommended for use in patients under 18 or over 65 due to limited safety data in these groups.

Side effects of Campral

Common side effects

Diarrhoea is the most frequently reported side effect of Campral, occurring in approximately 10 to 15% of patients. Other gastrointestinal effects include nausea, abdominal pain, vomiting, and flatulence.

These are usually mild to moderate in severity and often diminish with continued use. Maintaining adequate hydration and dietary fibre intake can help manage diarrhoea.

Uncommon and rare side effects

Skin reactions including rash, pruritus, and maculopapular eruptions have been reported uncommonly. Changes in libido (both increased and decreased) have been observed.

Psychiatric symptoms including anxiety, depression, and insomnia have been reported, although these are also common manifestations of alcohol dependence itself and may not be attributable to the medicine.

Very rare adverse events include hypersensitivity reactions (angioedema, anaphylaxis) and bullous skin reactions. If you develop swelling of the face, lips, tongue, or throat, or experience difficulty breathing, call 999 immediately.

When to seek medical advice

Contact your GP, alcohol treatment service, or call NHS 111 if you experience persistent diarrhoea that does not settle, a severe skin reaction, or significant mood changes.

If you have thoughts of self-harm or suicide, seek help immediately by calling 999, attending A&E, or contacting the Samaritans (116 123, available 24 hours).

Report any suspected adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Alcohol withdrawal management

Campral does not treat or prevent alcohol withdrawal. Withdrawal from alcohol can cause tremor, sweating, anxiety, agitation, seizures, hallucinations, and delirium tremens, which can be fatal if untreated.

Detoxification must be completed under medical supervision, typically using a reducing dose of a benzodiazepine (usually chlordiazepoxide in the community or diazepam in hospital settings).

Campral should only be initiated once the detoxification process is complete and the patient is abstinent.

Monitoring during treatment

Your prescriber or alcohol treatment service will review your progress regularly during the 12-month course of treatment.

Monitoring typically includes assessment of drinking status, review of side effects, renal function checks (particularly if there was pre-existing renal impairment), and evaluation of mental health.

Campral is most effective when combined with regular psychosocial support.

Pregnancy and breastfeeding

Campral should not be used during pregnancy or breastfeeding, as there are insufficient human safety data. Women of childbearing potential should use effective contraception during treatment. If you become pregnant while taking Campral, inform your prescriber immediately.

Campral versus other relapse prevention medicines

Three pharmacological options are licensed or recommended for alcohol relapse prevention in the UK: acamprosate (Campral), naltrexone, and disulfiram. Acamprosate modulates glutamate/GABA balance to reduce cravings.

Naltrexone blocks opioid receptors, reducing the pleasurable and reinforcing effects of alcohol.

Disulfiram inhibits the enzyme aldehyde dehydrogenase, causing an unpleasant reaction (flushing, nausea, vomiting, headache) if alcohol is consumed.

NICE recommends acamprosate or naltrexone as first-line options based on the evidence of efficacy and tolerability.

Disulfiram is recommended as a second-line option for patients who prefer a deterrent-based approach and can be supervised taking the medicine.

The choice between these medicines is made collaboratively between the patient and prescriber, taking into account patient preference, comorbidities, contraindications, and the availability of supervision for disulfiram.

How to access alcohol treatment and Campral in the UK

Campral is a prescription-only medicine (POM) in the UK.

It is most commonly prescribed through local alcohol treatment services (often commissioned by local authorities), which provide integrated assessment, detoxification, pharmacological treatment, and psychosocial support.

Your GP can refer you to your local alcohol service, or in many areas you can self-refer.

GPs can also prescribe Campral directly, particularly in areas where shared care arrangements exist between primary care and specialist alcohol services.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

If you are concerned about your drinking, you can contact your GP, call the national alcohol helpline Drinkline on 0300 123 1110 (weekdays 9am to 8pm, weekends 11am to 4pm), or find your local alcohol service through the NHS website at nhs.uk/live-well/alcohol-advice .

Alcoholics Anonymous (AA) meetings are available throughout the UK and can be found at alcoholics-anonymous.org.uk .

When to seek urgent medical advice

Contact your GP or call NHS 111 if you experience persistent or worsening side effects, significant mood changes, or difficulty maintaining abstinence despite treatment.

If you or someone around you develops signs of alcohol withdrawal (severe tremor, hallucinations, confusion, seizures), call 999 or attend A&E immediately, as alcohol withdrawal can be life-threatening.

If you are experiencing suicidal thoughts, call 999, attend A&E, or contact the Samaritans at 116 123 (free, 24 hours).

Report any suspected adverse reactions to Campral via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

• Campral EC 333 mg, Summary of Product Characteristics (EMC)
• Acamprosate calcium, British National Formulary (BNF)
• NICE CG115: Alcohol-use disorders, diagnosis, assessment and management
• Alcohol misuse, NHS
• Alcohol advice, NHS
• MHRA Yellow Card Scheme