Acamprosate

Buy Acamprosate () without prescription in Canada

In our Canadian pharmacy, you can buy Acamprosate (Campral) without a prescription, with delivery across Canada within 5‑14 days. Discreet and anonymous packaging.

Acamprosate, available in Canada under the brand name Campral, is a medication used to help people who are dependent on alcohol maintain abstinence after they have successfully stopped drinking. It works by restoring the natural balance between two key chemical messengers in the brain—glutamate and gamma‑aminobutyric acid (GABA)—which are disrupted by chronic heavy alcohol use. This stabilizing effect is thought to reduce the persistent craving and discomfort that can lead to relapse, making it easier to sustain long‑term sobriety.

Usual adult dose: The recommended dose is two 333 mg delayed‑release tablets (666 mg) taken orally three times daily, with or without food. For patients who weigh less than 60 kg, a reduced dose of four tablets daily in divided doses may be used. For patients with moderate renal impairment (creatinine clearance 30 to 50 mL/min), the dose should be reduced to one 333 mg tablet taken three times daily. Acamprosate is contraindicated in patients with severe renal impairment (creatinine clearance ≤ 30 mL/min). Treatment should begin as soon as possible after detoxification and be maintained even in the event of a relapse.

Dosage form: Delayed‑release (enteric‑coated) oral tablet, 333 mg.

Onset of action: Acamprosate is not intended to manage acute alcohol withdrawal. Its effects are cumulative, with significant improvements in abstinence rates observed when the medication is taken as part of a comprehensive psychosocial treatment program over a period of 3 to 12 months. The drug is absorbed slowly, reaching peak plasma concentrations within 3 to 8 hours after an oral dose.

Duration of action: The elimination half‑life of acamprosate is approximately 20 to 33 hours. Steady‑state plasma levels are typically reached within 5 days of regular three‑times‑daily dosing. The therapeutic effect persists as long as the medication is taken; discontinued use may lead to a return of cravings.

Alcohol recommendation: Acamprosate is intended for people who have already stopped drinking and is not known to interact directly with alcohol. If a relapse occurs, the patient should continue taking the medication and contact their healthcare provider immediately for support to stop drinking again.

Most common side effects: Diarrhoea (which occurs in up to 16% of patients and often resolves with continued use), headache, flatulence, nausea, vomiting, and dyspepsia. Other common effects include dizziness, pruritus (itching), dry mouth, insomnia, anxiety, and depression. Rare but serious side effects include suicidal ideation, acute kidney failure, and severe allergic reactions. The medication has no known significant drug interactions and is not metabolized by the liver, which sets it apart from many other drugs used in alcohol dependence such as naltrexone and disulfiram.

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General Information about Acamprosate

• INN (International Nonproprietary Name): Acamprosate Calcium (acamprosate calcique)
• Brand names available in Canada: Campral® (marketed by Mylan Pharmaceuticals ULC). No generic versions are currently marketed in Canada, though the product is available as a generic delayed‑release tablet internationally.
• ATC code: N07BB03 (Drugs used in alcohol dependence)
• Dosage forms and strengths: Delayed‑release (enteric‑coated) tablet, 333 mg (blister packs of 84 tablets). The tablet is white, round‑shaped, and debossed with “333” on one side.
• Manufacturers in Canada: Mylan Pharmaceuticals ULC (Campral). The product was originally submitted by Prempharm Inc. and is distributed by Mylan. Historically, Merck Canada was also involved in the product’s lifecycle.
• Registration status in Canada: Approved by Health Canada (Notice of Compliance issued 2007‑03‑16). DIN: 02293269. Status: Marketed.
• OTC / Rx classification: Prescription only (Rx). Schedule I drug under the Controlled Drugs and Substances Act. A valid prescription from a licensed Canadian healthcare professional is required.

Mechanism of Action and Pharmacology

While the precise mechanism of action of acamprosate is not fully understood, current evidence supports a model where it restores the balance between glutamatergic and GABAergic neurotransmission that is disrupted by chronic alcohol exposure. Alcohol acts as a central nervous system depressant, and long‑term heavy use causes the brain to compensate by increasing excitatory (glutamate) activity and decreasing inhibitory (GABA) activity. When a dependent person stops drinking, this imbalance persists, leading to a state of excessive neuronal excitability—sometimes called protracted withdrawal—which manifests as anxiety, insomnia, and intense craving. Acamprosate is believed to act primarily as a functional antagonist of glutamate by interacting with the N‑methyl‑D‑aspartate (NMDA) receptor and modulating calcium channels, thereby reducing this hyper‑excitability. At the same time, it enhances GABA transmission. This dual action helps to dampen the neural signals that drive the urge to drink, reducing the risk of relapse. Unlike naltrexone, which blocks the rewarding effects of alcohol, or disulfiram, which causes an aversive reaction, acamprosate acts by targeting the underlying neurobiological dysregulation.

Pharmacokinetically, the absolute oral bioavailability of acamprosate is low (approximately 11%), and food significantly reduces its absorption. The drug is not protein‑bound, is not metabolized by the liver, and is excreted almost entirely unchanged by the kidneys. This is a key clinical advantage: the lack of hepatic metabolism eliminates the potential for drug interactions with medications metabolized by the cytochrome P450 enzyme system. The elimination half‑life is approximately 20‑33 hours, and steady‑state plasma concentrations are achieved within 5 days of regular three‑times‑daily dosing.

Indications

• Maintenance of abstinence from alcohol in adults with alcohol dependence who are abstinent at treatment initiation. Treatment should be part of a comprehensive management program that includes psychosocial support and counselling.
• Acamprosate is not indicated for the treatment of acute alcohol withdrawal, and it has not been shown to be effective in patients who are still drinking when treatment begins.
• It is not recommended for use in paediatric patients; safety and efficacy have not been established in individuals under 18 years of age.
• The efficacy in promoting abstinence in patients with polysubstance abuse has not been adequately assessed.

Important Warnings and Precautions

At‑risk groups

• Pregnancy: Acamprosate calcium has been shown to be teratogenic in rats when given at doses approximately equal to the human dose, causing malformations including hydronephrosis, malformed iris, and retinal dysplasia. There are no adequate and well‑controlled studies in pregnant women. Acamprosate should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus. Women of childbearing potential should use effective contraception.
• Breastfeeding: Acamprosate is excreted in the breast milk of lactating rats; it is not known whether it is excreted in human breast milk. Because many drugs are excreted in human milk, breastfeeding is not recommended during treatment.
• Paediatrics (< 18 years): Safety and efficacy have not been established. Acamprosate is not recommended for use in children and adolescents.
• Elderly (≥ 65 years): Clinical studies of acamprosate did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently. Elderly patients are more likely to have decreased renal function, and because the drug is substantially excreted by the kidneys, dose reductions or closer monitoring may be necessary.
• Renal impairment: For patients with moderate renal impairment (creatinine clearance 30 to 50 mL/min), the dose should be reduced to one 333 mg tablet taken three times daily. Acamprosate is contraindicated in patients with severe renal impairment (creatinine clearance ≤ 30 mL/min). Renal function should be assessed before and during treatment.
• Hepatic impairment: No dose adjustment is required in patients with mild to moderate hepatic impairment (Child‑Pugh Class A or B). Data are not available for severe hepatic impairment (Child‑Pugh Class C), but because the drug is not metabolized by the liver, hepatic dysfunction is not expected to significantly affect its pharmacokinetics.
• Depression and suicidality: Cases of depression, suicidal ideation, and suicide have been reported in patients taking acamprosate. Alcohol‑dependent patients, including those taking acamprosate, should be monitored for the emergence of symptoms of depression and suicidal thinking. Patients and their families should be advised to report such symptoms immediately to the prescribing physician.
• Alcohol withdrawal symptoms: Acamprosate does not eliminate or diminish the symptoms of acute alcohol withdrawal. Patients must undergo medically supervised detoxification before starting therapy.
• Continued alcohol use: Although acamprosate does not interact with alcohol to cause a disulfiram‑like reaction, continued alcohol abuse while taking acamprosate will negate its therapeutic benefits. Patients should be counselled to contact their physician if they resume drinking.
• Allergy: Do not take Campral if you have a known hypersensitivity to acamprosate calcium or any of the nonmedicinal ingredients (colloidal anhydrous silica, crospovidone, magnesium silicate, magnesium stearate, microcrystalline cellulose, propylene glycol, sodium starch glycolate, talc, and anionic copolymer of methacrylic acid and acrylic acid ethyl ester).

Driving and alcohol

Acamprosate has not been shown to impair coordination, judgment, or motor skills in controlled studies. However, patients should take precaution when operating hazardous machinery, including automobiles, until they are reasonably certain that the medication does not affect their ability to participate in such activities. Some patients may experience dizziness or somnolence, which could impair driving performance. Unlike naltrexone or disulfiram, acamprosate does not interact directly with alcohol. There is no disulfiram‑like reaction if alcohol is consumed. However, patients should be aware that alcohol itself impairs coordination and judgment, and any drinking while taking the medication will counteract its therapeutic benefits.

Dosage Instructions

• Standard adult dose: The recommended dose is two 333 mg tablets (666 mg total) taken orally three times daily. The tablets should be swallowed whole, not crushed, chewed, or split, and may be taken with or without food. For patients who regularly eat three meals a day, taking the doses with meals can help improve gastrointestinal tolerance.
• Patients weighing less than 60 kg: A lower dose of two tablets in the morning, one tablet at midday, and one tablet at night (four tablets daily in divided doses) may be used.
• Moderate renal impairment (CrCl 30–50 mL/min): The dose should be reduced to one 333 mg tablet taken three times daily. Higher doses are not recommended.
• Severe renal impairment (CrCl ≤ 30 mL/min): Use is contraindicated.
• Hepatic impairment: No dose adjustment is required for patients with Child‑Pugh Class A or B hepatic impairment. No data are available for Class C.
• Initiation and duration: Treatment should begin as soon as possible after the patient achieves abstinence and should be maintained even if the patient relapses. The recommended duration of therapy is 12 months, although clinical trials have supported up to 24 months of continued benefit. Acamprosate should be used as part of a comprehensive psychosocial treatment program.
• Missed dose: If a dose is missed, the patient should take it as soon as remembered. If it is close to the time of the next dose, the missed dose should be skipped and the regular schedule resumed. Do not double doses.

Side Effects and Contraindications

• Most common side effects (incidence ≥ 5% or greater than placebo): Diarrhoea (10‑16%), headache, flatulence, nausea, vomiting, dyspepsia, pruritus, dry mouth, dizziness, insomnia, anxiety, and depression. Diarrhoea is the most frequent adverse effect and is usually transient, often resolving with continued treatment or dose reduction.
• Less common but serious side effects: Suicidal ideation and suicide attempts; depression and worsening of pre‑existing mood disorders; acute kidney injury; and severe allergic reactions including angioedema, urticaria, and maculopapular rash.
• Post‑marketing experience (rare): Serious adverse events reported in the non‑US postmarketing evaluation have included cardiomyopathy, deep thrombophlebitis, heart failure, mesenteric arterial occlusion, and shock. Acute kidney failure has been temporally associated with acamprosate treatment in at least three cases.
• Contraindications: Known hypersensitivity to acamprosate calcium or any component of the tablet. Severe renal impairment (creatinine clearance ≤ 30 mL/min). Breastfeeding.

Drug Interactions

• General statement: Acamprosate has a unique pharmacokinetic profile; it is not metabolized by the liver, does not bind to plasma proteins, and is excreted unchanged by the kidneys. Consequently, it has no known clinically significant drug‑drug interactions. Formal studies have shown that acamprosate does not affect the pharmacokinetics of alcohol, diazepam, disulfiram, imipramine, or naltrexone, and its own pharmacokinetics are not affected by these agents.
• Naltrexone: Co‑administration of acamprosate with naltrexone leads to a 33% increase in the C_max and a 25% increase in the AUC of acamprosate. No dose adjustment is recommended, and the combination is frequently used in clinical practice for patients who do not respond adequately to either agent alone.
• Disulfiram: There is no interaction between acamprosate and disulfiram. The two can be used together when clinically indicated, though this combination is less common.
• Alcohol: Acamprosate does not affect the pharmacokinetics of alcohol, and alcohol does not alter the pharmacokinetics of acamprosate. There is no disulfiram‑like reaction. Nevertheless, patients are counselled not to drink, as continued alcohol use will counteract the therapeutic effect.
• Food: Food significantly decreases the oral bioavailability of acamprosate. However, to improve gastrointestinal tolerability, the medication can be taken with meals. Because the reduction in absorption from food is consistent, the resulting plasma levels remain within the therapeutic range when taken with meals three times daily.

Practical Advice

• Administration: Take the delayed‑release tablet whole with a glass of water. Do not crush, chew, or split the tablet, as the enteric coating is designed to protect the drug from stomach acid. Taking it with meals or just after eating can help reduce diarrhoea and stomach upset. Adherence to the three‑times‑daily regimen is important for maintaining steady therapeutic levels.
• Monitoring: Baseline assessment of renal function (serum creatinine and estimated creatinine clearance) is recommended before starting therapy and periodically during treatment, especially in patients over 65 years of age. Patients should be monitored for the emergence or worsening of depressive symptoms and suicidal ideation. A pregnancy test should be considered in women of childbearing potential before initiating treatment. Weight should be monitored periodically.
• Storage: Store at room temperature (15‑30 °C) in a dry place, protected from moisture and light. Keep in the original blister packaging until use. Keep out of the reach and sight of children.
• Lifestyle: Acamprosate works best when combined with a comprehensive treatment program that includes counselling, psychosocial support, and a commitment to abstinence. It does not help with acute withdrawal symptoms; medically supervised detoxification must be completed first. Continue taking the medication as directed, even if a lapse occurs, and contact your healthcare provider immediately for help in stopping drinking again. The medication may take several weeks to produce noticeable effects, so patience and consistency are essential. Avoid alcohol entirely.
• Missed dose: If you miss a dose, take it as soon as you remember on the same day. If it is close to the time of your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one.
• When to seek medical review: Contact your doctor immediately if you experience thoughts of harming yourself, new or worsening depression, severe or persistent diarrhoea leading to dehydration, signs of an allergic reaction (rash, hives, swelling of the face, lips, or throat, difficulty breathing), or if you become pregnant while taking this medication. If you relapse and begin drinking again, inform your healthcare provider promptly so that appropriate support can be arranged.
• Disposal: Return unused or expired medication to a pharmacy for safe disposal. Do not flush down the toilet or discard in household waste.

Alternative Medications

• Naltrexone (Revia®): An opioid receptor antagonist that blocks the pleasurable effects of alcohol and reduces the rewarding sensation that drives heavy drinking. Unlike acamprosate, naltrexone does not require abstinence prior to initiation, and it reduces the frequency and severity of lapses rather than solely supporting full abstinence. It is metabolized by the liver and carries a risk of hepatotoxicity, particularly at higher doses. A long‑acting injectable form (Vivitrol®) is also available. Naltrexone and acamprosate may be combined for patients who do not respond adequately to either agent alone.
• Disulfiram (Antabuse®): An aversive agent that blocks the enzyme aldehyde dehydrogenase, causing a highly unpleasant physical reaction (flushing, nausea, vomiting, tachycardia) when alcohol is consumed. Unlike acamprosate, disulfiram does not reduce craving; it relies on a psychological deterrent effect. It is not available as a regularly marketed brand‑name product in Canada, but may be accessible through the Health Canada Special Access Programme. It is contraindicated in severe cardiac disease and psychosis. Acamprosate and disulfiram can be used together when clinically indicated, although this practice is uncommon.
• Gabapentin (Neurontin®): An anticonvulsant used off‑label for alcohol use disorder. It is particularly useful in patients with alcohol withdrawal symptoms and co‑occurring anxiety or neuropathy. Unlike acamprosate, gabapentin can be initiated while the patient is still drinking.
• Topiramate (Topamax®): An anticonvulsant used off‑label to reduce heavy drinking days. It acts through multiple mechanisms, including GABA enhancement and glutamate antagonism, but its side‑effect profile (cognitive dulling, weight loss, paraesthesia) limits its use. It is not approved by Health Canada for this indication.
• Baclofen (Lioresal®): A muscle relaxant used off‑label in alcohol dependence, particularly in patients with liver disease, as it is excreted primarily by the kidneys. Evidence for its effectiveness is mixed, and Canadian guidelines consider it a third‑line agent.
• Psychosocial interventions: For patients who cannot or will not take pharmacotherapy, structured cognitive‑behavioural therapy (CBT), motivational interviewing, 12‑step facilitation programs (e.g., Alcoholics Anonymous), and intensive outpatient treatment are effective, evidence‑based approaches. Pharmacotherapy combined with psychosocial support yields the best outcomes.

Clinical Efficacy

The efficacy of acamprosate in supporting abstinence from alcohol is well established through a robust body of clinical research. A landmark meta‑analysis of 24 randomized controlled trials involving 6,915 participants found that acamprosate, compared with placebo, significantly reduced the risk of any alcohol consumption after detoxification (relative risk [RR] 0.86, 95% CI 0.81–0.91), increased the cumulative abstinence duration by an average of 11 days (95% CI 5.08–16.81), and increased the rate of complete abstinence at 6 months (36.1% vs. 23.4%). Another systematic review focusing on seven pooled European trials involving 1,485 alcohol‑dependent patients found that acamprosate effectively maintained continuous abstinence irrespective of disease severity or the type of accompanying psychosocial support.

Clinically, acamprosate and naltrexone are often compared. Research published in the Journal of the American Medical Association (JAMA) and other high‑impact journals suggests that acamprosate may be more effective at helping people abstain from drinking entirely, whereas naltrexone may be better at reducing heavy drinking days. A direct comparison found that acamprosate and naltrexone were similarly effective, with neither drug demonstrating a clear superiority over the other. Guidelines from the Canadian Centre on Substance Use and Addiction, the American Psychiatric Association, and the European Federation of Neurological Societies all recommend acamprosate as a first‑line pharmacotherapy for alcohol dependence, particularly in patients whose treatment goal is complete abstinence.

The medication is generally well tolerated over the long term. A study conducted in a family medicine clinic setting found that acamprosate was safe and well tolerated in a broadly inclusive sample and effective in populations of patients motivated to have a treatment goal of abstinence. Data on the medication's long‑term cardiovascular safety are also reassuring; a large cohort study comparing new users of acamprosate with matched new users of naltrexone found that acamprosate was not associated with an increased risk of cardiovascular events, including cardiomyopathy, which had been a concern raised in early post‑marketing reports. Unlike naltrexone and disulfiram, acamprosate has no potential for abuse, is not a controlled substance, carries no black box warnings, and is not hepatotoxic—making it a particularly safe option for patients with co‑occurring liver disease.

Important:

Acamprosate (Campral) is a prescription medication that should be used only under the supervision of a qualified healthcare professional. It is intended to be used as part of a comprehensive treatment program that includes psychosocial support and counselling, and it is not a substitute for professional treatment of alcohol dependence. This medication will not prevent the symptoms of alcohol withdrawal; you must be abstinent from alcohol before starting it. Tell your doctor immediately if you develop new or worsening depression, have thoughts about harming yourself or others, or experience any unusual changes in mood or behaviour. If you relapse and begin drinking again, do not stop taking the medication; continue as directed and contact your healthcare provider immediately for support. Acamprosate can cause fetal harm in animal studies and should be used during pregnancy only if clearly needed. Breastfeeding is not recommended during treatment. If you experience a severe allergic reaction, including swelling of the face, lips, or throat, difficulty breathing, or a severe skin rash, stop taking the medication and seek emergency medical attention. This information is not a substitute for professional medical advice, diagnosis, or treatment.

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