A Comprehensive Monograph on Acamprosate (DB00659)

Section 1: Executive Summary & Introduction

Acamprosate, chemically known as calcium acetylhomotaurinate, is a centrally acting small molecule drug established as a cornerstone in the pharmacotherapeutic management of Alcohol Use Disorder (AUD).[1] It is one of only three medications approved by the U.S. Food and Drug Administration (FDA) for this indication, alongside disulfiram and naltrexone, and was the first agent specifically formulated for the maintenance of alcohol abstinence in patients following detoxification.[1] The core therapeutic principle of acamprosate is to support sustained sobriety by reducing alcohol cravings and mitigating the protracted withdrawal symptoms that often lead to relapse.[4] It achieves this not by inducing an aversive reaction to alcohol, as seen with disulfiram, but by targeting the underlying neurobiological dysregulation caused by chronic alcohol consumption.[5] Specifically, acamprosate is hypothesized to restore the homeostatic balance between the brain's primary excitatory (glutamate) and inhibitory (gamma-aminobutyric acid, or GABA) neurotransmitter systems, which is profoundly disrupted by long-term alcohol exposure.[4]