Review of acamprosate pharmacokinetics and dosing strategies

Alcohol use disorder (AUD) is associated with significant morbidity and mortality, contributing to 5% of annual deaths. Although some literature suggests that acamprosate is an effective treatment for AUD, its traditional dosing regimen of 2 tablets 3 times daily may challenge patient adherence. This review compares clinical and pharmacokinetic data of different acamprosate dosing regimens to provide guidance on optimal dosing for treating AUD.

A comprehensive literature search was performed for articles published before March 2024. Relevant randomized controlled trials, case reports, and pharmacokinetic studies were identified from PubMed, PubMed Central, and Google Scholar.

Three dosing regimens were identified, including traditional dose, reduced dose, and reduced frequency. Definitive conclusions regarding the comparative efficacy of these regimens cannot be drawn. However, reduced doses appear safe and efficacious in small clinical trials, and a pharmacokinetic study found reduced frequency to be bioequivalent to traditional doses.

Adherence to pharmacotherapy for AUD is challenging and difficult to measure. A reduced dose regimen may be appropriate for patients who struggle with the pill burden of traditional doses, though the varying number of tablets required at different times may still pose adherence issues. The bioequivalence of reduced frequency dose to traditional dose suggests it could be a viable option for patients who find a 3-time daily frequency cumbersome. However, the lack of data on the clinical efficacy of reduced frequency makes it difficult to recommend as a primary regimen. Further research is needed to determine if either reduced dose or reduced frequency regimens could improve patient adherence compared with a traditional dose.