Acamprosate (Aotal®):: Could adverse effects upset the treatment of alcohol dependence?

Acamprosate, a stimulant of central inhibitory GABA neurotransmision and an antagonist of excitatory amino acids, is used in alcohol withdrawal and for the maintenance of abstinence. After identification of several cases of treatment discontinuation during alcohol abstinence because of acamprosate-induced adverse drug reactions (ADRs), a retrospective study was conducted in order to investigate and quantify acamprosate-induced ADRs. Up to July 2002, 472 patients were included for treatment of alcohol withdrawal: of these, 68% (n = 322) received acamprosate. At least one ADR occurred in 98 patients (30%). The mean age of the patients was 41.5 +/- 8.8 years (range: 24-65) and 70% were male. All ADRs were classified as 'non serious'. However, ADRs required a dose decrease in 61 cases or acamprosate discontinuation in 76 cases (62.2% and 77.5%, respectively, of patients with an ADR). We identified mainly gastrointestinal ADRs in 67 patients (mean delay before occurrence: 7.6 days), i.e. 20.8% of patients treated with acamprosate (corresponding to 68.3% of ADRs), with a positive rechallenge in five cases. Moreover, cutaneous ADRs (pruritus) occurred in 29 patients (mean delay before occurrence: 9.0 days), and required acamprosate withdrawal in 22 patients (75.9%) with a prior dose decrease in 18 of these patients (62.1%). Our results show that a dose decrease or withdrawal of acamprosate was necessary in 18.9% and 23.6%, respectively, of patients because of the occurrence of ADRs. The present study shows the important role of acamprosate-induced ADRs among the various causes for failure of alcohol abstinence.