Have you heard of these medications that can help you stop drinking alcohol? Acamprosate vs naltrexone, which one works best?
If you are concerned about gray area drinking, occasional, or frequent drinking binges, or even heavy daily drinking, you may be interested in medical treatment to help you slow down or quit. There are two medications available that you can take after you quit drinking to help with alcohol withdrawal and cravings. One of them, you can even take before you quit drinking.
What is acamprosate?
Also known by the brand name Campral, acamprosate calcium is a medication used to treat alcohol use disorder. It is an alternative to naltrexone to help maintain sobriety.
How does it work?
Scientists believe that acamprosate works in two different ways in the central nervous system. It works on GABA receptors to increase the activity of the neurotransmitter GABA. And, it is an antagonist of the NMDA receptor.
If you have just quit drinking, acamprosate will stabilize chemical signaling in the brain so you will have less of an issue with withdrawal symptoms. Acamprosate, developed in 1989, was approved to treat alcohol use disorder by promoting abstinence in 2004.
What about naltrexone?
Doctors prescribe naltrexone for patients with alcoholism and opioid use disorder. Naltrexone, discovered in 1963, was approved for treating opioid dependence in 1984 and for alcohol dependence in 1995. Many studies have demonstrated the efficacy of naltrexone from the time of its discovery in the early sixties. Naltrexone is an opioid receptor blocker. Naltrexone is also available as a monthly injection, named Vivitrol.
If I want to start Campral or naltrexone, do I have to stop heavy drinking first?
Experts disagree on the best way to stop drinking alcohol. Many addiction experts believe that you should stop drinking right away and undergo medically supervised detox.
However, other experts maintain that gradually reducing alcohol intake with medical treatment is the best long-term solution. FDA literature recommends against using acamprosate before you quit drinking.
Therefore, it may be useful for patients after completing an alcohol detox program. Naltrexone, on the other hand, can be started right away.
Even if you have not stopped drinking, you can start taking naltrexone. The Sinclair Method, or TSM, is an alternative way to quit drinking that does not require inpatient detox treatment programs. Patients who follow TSM protocols take naltrexone and reduce their drinking gradually.
Can acamprosate and naltrexone be combined?
There have been studies where patients took both drugs. Because the two drugs work in different ways, patients can take the two medicines together.
Studies indicate that the two drugs combined are more effective than acamprosate alone. However, it is unclear that the combination is superior to naltrexone alone. Either way, experts recommend psychotherapy in conjunction with the medical treatment of alcohol dependence.
Does acamprosate get you high?
Based on the proposed mechanisms of action of the drug, you might conclude that Campral can get you high.
First, as a Gaba receptor modulator, it works similarly to benzodiazepines, a class of potent tranquilizers. Yet, Campral does not cause the intoxication that results from benzodiazepine use. Second, it is an NMDA receptor antagonist.
Other NMDA receptor antagonists include PCP (Phencyclidine), Nitrous Oxide, Ketamine, Esketamine, diethyl ether, Dextromethorphan (DXM), and many others. Even the hallucinogenic drug, ibogaine, used in other countries to treat addiction and chronic pain, is an NMDA receptor antagonist.
You may recognize some or all of these drugs as drugs known to get people high. Drug users have found ways to get high from a variety of NMDA receptor agonists from cat tranquilizers to cough syrup.
While this class includes intoxicating drugs, controlled drugs, and even illegal street drugs, Campral is not a drug of abuse. The “high” associated with a disassociative anesthetic, such as Ketamine, does not occur at all with Campral.
Which has worse side effects, naltrexone or Acamprasole?
Naltrexone has side effects, such as insomnia, anxiety, nausea, and headaches. Rarely it can cause liver problems and should not be used in patients with liver problems. For patients who take opioids, naltrexone will cause precipitated opioid withdrawal. Overall, patients tend to tolerate naltrexone well.
Campral carries the risk of multiple side effects. The list of side effects and adverse reactions include abnormal heart rhythms, high blood pressure, diarrhea, and decreased sex drive. If you have kidney problems, you must not take Campral at all.
Are there any benefits to taking acamprosate beyond helping with alcohol withdrawal?
Studies have revealed that the drug may also be neuroprotective. Campral may protect neurons from the damaging effects of alcohol withdrawal. It may even protect the brain from neurotoxicity in general.
It is interesting that another NMDA receptor antagonist, memantine, or Namenda, is known to protect neurons. Doctors prescribe Namenda to treat Alzheimer’s dementia.
Does naltrexone have additional benefits?
Naltrexone helps to modify behavior and learned habits by blocking opioid receptors from the effects of endorphins. The mechanism of naltrexone’s action occurs mostly in the brain’s reward system and pleasure center, the nucleus accumbens.
Naltrexone has proven benefits for people who suffer from binge eating disorder. Studies have also demonstrated potential in treating stimulant addiction, including cocaine and methamphetamine addiction. Low dose naltrexone may have even more benefits.
What is Low Dose Naltrexone?
Some doctors prescribe naltrexone at low doses, about a tenth of the standard dosage, off-label. They use it to treat various medical conditions, including Crohn’s disease, multiple sclerosis, fibromyalgia, and chronic fatigue syndrome.
Proponents of LDN believe that the drug stimulates endorphin production, enhances the immune system, and has anti-inflammatory effects. Dr. Bernard Bihari, known as the father of low dose naltrexone, has even proposed that LDN may improve COVID-19 outcomes.
The proposed mechanisms of LDN boosting the immune system does indicate the possibility of enhancing immune responses to the novel coronavirus.
Which is better, naltrexone, or Campral?
Both drugs are effective for relapse prevention. When considering which medical treatment is best, safety is the most critical consideration. After drug safety, we must consider efficacy and cost. In our comparison of acamprosate to naltrexone, it would seem that naltrexone comes out clearly on top.
Naltrexone has fewer side effects, and you can take it before you stop drinking. It blocks cravings for alcohol and retrains the brain to extinguish the habit of enjoying drinking alcohol. Is there any situation where you would choose acamprosate over naltrexone?
Why would I choose Campral over naltrexone?
A patient who has a liver problem may be able to take acamprosate. They would not be able to take naltrexone. I recommend a consultation with a liver specialist to patients with liver problems, such as elevated liver function tests.
Because acamprosate does not block opioid receptors, it can be taken by patients who take prescription opioids. Another possible reason to choose Campral is if a patient does not have success with naltrexone. They may be interested in trying an alternative.
How do patients take Campral?
Campral is available in a 333mg tablet. The FDA approved indication is to take Campral to maintain abstinence from alcohol. The patient must be abstinent before starting acamprosate.
The recommended dosage is 666mg by mouth, three times daily. That means a patient would take six tablets daily. A month’s supply would be 180 tablets.
How do patients take naltrexone?
Naltrexone is available as a 50 mg tablet. The recommendation is to take it by mouth daily. The alternative is to follow.
The Sinclair Method and take it as needed, one hour before drinking. In some cases, a higher dosage may be necessary.
How much do these medications cost?
According to GoodRx.com, using their discount card, the price of acamprosate is as low as $83.26 for 180 generic 333mg tablets.
The price of 30 tablets of generic naltrexone 50mg is as low as $21.63. These prices vary over time and they vary by pharmacy and medication. In this case, the best price was Walmart.
The length of treatment is typically at least 12 months with either medication. In some cases, patients take naltrexone indefinitely.
Naltrexone is generally the best choice for treating alcohol abuse.
While there are reasons to choose Campral over naltrexone, generally, naltrexone will be the best choice. Some doctors will even prefer to use both medications together. Of course, they will have to consider the possibility of additional side effects from Campral.
For patients interested in The Sinclair Method, naltrexone is the drug that makes this alcohol treatment possible. Naltrexone helps to reduce cravings for alcohol.
It works by what Dr. Sinclair described as “pharmacological extinction.” The retraining of the brain’s reward center with naltrexone is similar to Dr. Ivan Pavlov’s research.
In the early 20th century, Dr. Pavlov won the Nobel Prize. He was the first Russian Nobel laureate for his groundbreaking work that is now the foundation of The Sinclair Method.
Naltrexone is an intriguing medication with a long history of use. Many studies, including double-blind and placebo-controlled trials, have demonstrated how effective and safe naltrexone is in treating alcohol use disorder.
Are you ready to put your drinking days behind you?
Consider asking your doctor about acamprosate or naltrexone. Combined with psychotherapy, these medications provide effective treatment for alcohol use disorder.