Initiating Acamprosate during Alcohol Detoxification Is Not Beneficial and May Be Harmful

Acamprosate is an FDA-approved treatment for alcohol dependence that is generally initiated after patients have achieved abstinence. There have been no clinical trials comparing the results when acamprosate is initiated during alcohol detoxification versus after detoxification. In this exploratory trial, researchers randomly assigned 40 alcohol-dependent patients to either acamprosate (1998 mg per day) or placebo during outpatient detoxification of 5–14 days followed by a 10-week rehabilitation phase during which all subjects received acamprosate and weekly counseling.

• Thirty-four patients (85%) completed the detoxification phase. There was no difference in detoxification completion rates between groups.

• Patients in the placebo group had better results on 5 of 7 secondary measures during detoxification (withdrawal symptoms, oxazepam prescribed, duration of detoxification, heavy drinking days, and drinks per drinking day), although these differences were not significant.

• During the rehabilitation phase, patients who had been treated with acamprosate during detoxification had a higher percentage of heavy drinking days (30% versus 11%) and more drinks per drinking day (8.1 versus 4.7) than patients in the placebo group.

• There was no significant difference between groups on secondary measures during the rehabilitation phase (Addiction Severity Index score, Penn Alcohol Craving Scale score, and Hamilton Rating Scale scores for depression and anxiety).

Comments:

Although this study does not exclude the possibility of a small benefit from initiating acamprosate during detoxification, it strongly suggests this practice is potentially harmful and should not be implemented until there is compelling evidence of a benefit.

Darius Rastegar, MD

Reference:

Kampman KM, Pettinati HM, Lynch KG, et al. Initiating acamprosate within-detoxification versus postdetoxification in the treatment of alcohol dependence. Addict Behav. 2009;34(6–7):581–586.