Acamprosate: what it treats, how to take it, side effects
Last updated September 3, 2026.
Acamprosate helps brains changed by long-term heavy drinking work normally again. You may know it as Campral. It is maintenance medication for sobriety - paired with counseling and support, started after the drinking has already stopped.
What does it treat?
Alcohol dependence - specifically, avoiding a return to drinking after stopping. The boundaries matter: it does not prevent withdrawal symptoms, and it has not been shown to work in people who have not stopped drinking or who also overuse street drugs or prescription medications.
How do you take it?
Two tablets three times a day, with or without food - breakfast, lunch, and dinner anchoring is the recommended memory trick. Swallow whole, never split, chew, or crush. It only works while you take it, so continue even when a drink feels unthinkable. And the slip rule, straight from the label: if you drink alcohol while taking it, keep taking the medication and call your doctor - it will not punish you with a reaction, and the slip is a reason to tighten the plan, not abandon it. Missed dose: take it when you remember unless the next one is close; never double up.
Side effects to know
- Common: diarrhea - the signature one - plus gas, upset stomach, appetite loss, dry mouth, dizziness, itching, weakness, nausea, anxiety, sleep trouble, and sweating.
- Serious - call your doctor immediately: burning, tingling, or numbness in the hands, feet, arms, or legs, and rash.
Who should not take it?
Flag kidney disease - the drug clears through the kidneys, and impaired kidneys change the dose or rule it out. Depression and suicidal thinking deserve mention before starting, because recovery itself shifts mood. If you become pregnant, call your doctor.
When is it an emergency?
A spreading rash, or numbness and tingling that is progressing, warrants same-day care. In any mental-health crisis, the 988 Suicide and Crisis Lifeline (call or text 988) is free, confidential, and 24/7. For an overdose, call Poison Control at 1-800-222-1222. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Why three times a day?
The drug clears quickly, so steady coverage takes three doses - and the design assumes a routine: MedlinePlus suggests breakfast, lunch, and dinner anchoring to keep all three. Missed doses thin the protection, which matters because acamprosate only helps while you are taking it. The meal anchor converts a chore into a habit.
What happens if I drink while taking acamprosate?
Nothing dangerous from the combination - MedlinePlus is explicit that acamprosate will not cause an unpleasant reaction with alcohol, unlike disulfiram. The instruction for a slip is specific and humane: continue the medication and call your doctor. A slip is data about where the plan needs reinforcement - the meeting, the triggers, the dose - not a reason to stop the medication and stack relapse on slip.
How is acamprosate different from naltrexone and disulfiram?
Three different strategies. Acamprosate normalizes brain chemistry changed by long-term drinking - it reduces the background discomfort that drives the urge. Naltrexone blocks the reward - drinking on it delivers less payoff. Disulfiram makes drinking physically punishing. All three pair with counseling; none is a standalone cure. The choice between them is a real clinical conversation about your pattern, your history, and your other conditions.
Why did my doctor check my kidneys first?
Acamprosate leaves the body almost entirely through the kidneys - impaired kidneys let it accumulate, changing the dose or ruling the drug out entirely. The kidney question is the main medical screen before starting. For healthy kidneys it is a well-tolerated drug; for reduced function, the prescriber recalculates.
Why did the diarrhea happen - and will it last?
The most common effect by far, arriving in the first weeks and usually fading as the body adjusts. It is annoying but manageable: hydration, smaller blander meals, and time. Diarrhea that is severe, bloody, or persistent past the first weeks earns a call - mostly to make sure something else is not going on.
What happens if I miss a dose of acamprosate?
Take it as soon as you remember, unless it is almost time for the next one - then skip it and never double up. With three doses a day, the meal anchor does the heavy lifting: the medication sits next to where you eat, and the dose rides the habit that already exists.