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drferdia

Acamprosate

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Which of the following is correct with regard to acamprosate?

1) Can be used with controlled drinking.  

2) Is associated with abuse potential.  

3) Acts in a dose-dependent fashion.    

4) Reduces craving for alcohol

5) Can be used for opioid withdrawal

Is it 4) or 3)?  :-? Please provide any evidance for the answer

Thanks

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It can be used e controlled drinking can also be a correct option

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I would go with the straight farward answer which is reduces craving for alcohol.

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It can be used e controlled drinking can also be a correct option

no u dont give acamprosate for controlled drinkers, only abstainers

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Which of the following is correct with regard to acamprosate?

1) Can be used with controlled drinking.  

2) Is associated with abuse potential.  

3) Acts in a dose-dependent fashion.    

4) Reduces craving for alcohol

5) Can be used for opioid withdrawal

Is it 4) or 3)?  :-? Please provide any evidance for the answer

Thanks

the most appropriate answer here is reduces craving for alcohol

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yep, a small medline search shows many papers showing dose depemndent effect for acamprosate; also no demonstrable anti-craving effect.

I will go with dose dependent, thanks for highlighting this question

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i thought it was reduces craving

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I think the answer would be - it reduces craving.

' dose dependent fashion -' i don't think it's the correct answer

When u start Acomprosate u would start either 666mg tds or

acoprosate 666mg od and 333mg bd depends on the body weight and age.We are not titratring the dose here.So how it could be dose dependent fashion.

correct me if i am wrong.

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I think the answer would be - it reduces craving.

' dose dependent fashion -'  i don't think it's the correct answer

When u start Acomprosate u would start either 666mg tds  or

acoprosate 666mg od and 333mg bd depends on the body weight and age.We are not titratring the dose here.So how it could be dose dependent fashion.

correct me if i am wrong.

Thats a very good point terminal 5...

I dont know if the dose dependency of acamp has been tested in humans... But it has been very well established in Rats...

My arguement would be, the very fact that Acamp is given at a fixed dose of 1998mg is because it is not effective at a lower dose... and hence dose dependent...

(like I said, I am not sure if there has been head to head studies with different doses in humans...)

But that said, it is touted to be an anticraving drug... (unless recent papers show that it really does not have any effect on craving)

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SPMM seem to have given a huge list of reference articles for this question

personally i will stick with reduces craving for alcohol :)

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I think the answer would be - it reduces craving.

' dose dependent fashion -'  i don't think it's the correct answer

When u start Acomprosate u would start either 666mg tds  or

acoprosate 666mg od and 333mg bd depends on the body weight and age.We are not titratring the dose here.So how it could be dose dependent fashion.

correct me if i am wrong.

Thats a very good point terminal 5...

I dont know if the dose dependency of acamp has been tested in humans... But it has been very well established in Rats...

My arguement would be, the very fact that Acamp is given at a fixed dose of 1998mg  is because it is not effective at a lower dose... and hence dose dependent...

(like I said, I am not sure if there has been head to head studies with different doses in humans...)

But that said, it is touted to be an anticraving drug... (unless recent papers show that it really does not have any effect on craving)

my thoughts as well.c great minds think alike :lol:

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It does not say anywhere in SPMM that Acamprosate is dose dependant as it is not, I've just checked it myself. The dose is weight dependant - true.

It is NEVER given with alcohol re:control drinking.

It is prescribed just for craving straight after detox for 1 year. I am surprised to see such a discussion, this info is written everywhere.

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Do acamprosate or naltrexone have an effect on daily drinking by reducing craving for alcohol?.

RESEARCH REPORT

Addiction. 103(6):953-959, June 2008.

Richardson, Kylie 1; Baillie, Andrew 2; Reid, Sophie 3; Morley, Kirsten 1; Teesson, Maree 4; Sannibale, Claudia 3,4; Weltman, Martin 5,6; Haber, Paul 1,3,4

Abstract:

Aim: To explore the effect of acamprosate and naltrexone on craving and alcohol consumption in the treatment of alcohol dependence.

Design: A randomized, double-blind, single-dummy, placebo-controlled trial.

Setting: Three treatment centres in Sydney, Australia.

Participants: A total of 169 alcohol-dependent subjects were given naltrexone (50 mg/day), acamprosate (1998 mg/day) or placebo for 12 weeks, in conjunction with manualized medication compliance therapy.

Intervention: During the course of the trial, participants kept a daily diary which included the number of standard drinks they consumed and their peak craving for alcohol that day rated on a 0-10 scale.

Measurements: Subjective ratings of daily craving and daily drinking for the first 6 weeks of treatment.

Findings: Mixed/hierarchical linear models were employed on an intention-to-treat basis. Analyses revealed that craving was a significant predictor of daily drinking and baseline levels of depression were the best predictor of daily craving. There was no significant improvement in model fit when treatment group was added both in models of daily craving and daily drinking. Daily alcohol consumption was best predicted by a model incorporating baseline dependence and depression scores, and daily craving, entered as a time-varying covariate. However, there was a significant craving x time x treatment interaction (t = -3.365, df = 4413.712, P < 0.001), suggesting that at higher levels of craving drinking was reduced at a significantly greater rate with naltrexone compared to acamprosate.

Conclusions: Naltrexone had a greater effect on drinking when craving was high. These results support the role of naltrexone in reducing craving when that craving is highly salient. The role of acamprosate in reducing craving was not supported by these findings.

Copyright © 2008 Blackwell Publishing Ltd.

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and may i add this is the only such double blind RCT exploring specific effects on craving!

the answer is given in self test section of spmm notes

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This is the only study and done in Australia, not in the UK

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It does not say anywhere in SPMM that Acamprosate is dose dependant as it is not, I've just checked it myself. The dose is weight dependant - true.

It is NEVER given with alcohol re:control drinking.

It is prescribed just for craving straight after detox for 1 year. I am surprised to see such a discussion, this info is written everywhere.

Action of acamprosate is dose dependent

This is taken from BJP 1997, July...

Efficacy and safety of acamprosate in the treatment of detoxified alcohol-dependent patients. A 90-day placebo-controlled dose-finding study

I Pelc, P Verbanck, O Le Bon, M Gavrilovic, K Lion and P Lehert

Psychiatry Department, Brugmann University Hospital, Brussels, Belgium.

BACKGROUND: Acamprosate is a newly registered drug that appears to reduce alcohol-drinking in both animal models and clinical conditions. METHOD: In order to assess the efficacy and safety of the drug in the treatment of detoxified alcoholics, we performed a 90-day double-blind trial comparing two dosages of acamprosate (1332 mg/day and 1998 mg/day). RESULTS: [highlight]For all efficacy parameters, acamprosate appeared to be significantly superior to placebo, with a trend towards a better effect at the higher dosage.[/highlight] Furthermore, acamprosate appeared to be extremely safe. CONCLUSION: This study confirms that acamprosate could be an interesting adjuvant for maintaining abstinence in detoxified alcoholics.

The second human study...

Alcohol and alcoholism journal 1995 March...

DOUBLE-BLIND RANDOMIZED MULTICENTRE TRIAL OF ACAMPROSATE IN MAINTAINING ABSTINENCE FROM ALCOHOL

FRANÇOIS M. PAILLE*, JULIEN D. GUELFI1, ALAN C. PERKINS2, RENÉ J. ROYER3, LUCIEN STERU4 and PHILIPPE PAROT*

Centre d'Alcoologie, Hôpital Fournier 36 quai de la Bataille. F-54035 Nancy cedex

1Clinique des Maladies Mentales et de l'Encéphale. Hôpital Sainte-Anne Service du Pr Samuel-Lajeunesse. 100 rue de la Santé, F-75674 Paris cedex 14, France

2 MEDIANS, Waverley, School Hill, Wargrave, Reading RG10 8DY, UK

3Laboratoire de Pharmacologie, Faculté de Médecine avenue de la Forêt de Haye, F-54500 Vandoeuvre, France

4 ITEM, 93 avenue de Fontaineblav, F-94297 Le Kremlin-Bicêtre, France

*Author to whom correspondence should at addressed

Received 11 May 1994; first review notified 12 August 1994; accepted 8 September 1994

A prospective placebo-controlled, randomized double-blind study of Acamprosate at two dose levels in alcohol-dependent patients followed up for 12 months was performed. After detoxification, each of the 538 patients included was randomly assigned to one of three groups: 177 patients received placebo, 188 received Acamprosate at 1.3 g/day (low dose group) and 173 received 2.0g/day (high dose group) for 12 months. This was followed by a single blind 6 month period on placebo. The patients' mean age was 43.2 ± 8.6 years. Their mean daily alcohol intake was high (nearly 200g/day) and of long duration (9.5 ± 7.1 years). [highlight]Abstinence figures followed the order high dose>low dose>placebo.[/highlight] The difference was significant at 6 months (P 0.02) but not at 12 months (P = 0.096). The number of days of continuous abstinence after detoxification was 153 ± 197 for the high-dose group versus 102 ± 165 for the placebo group (P = 0.005), with the lose-dose group reporting 135 ± 189 days. Clinic attendance was significantly better in the Acamprosate groups than in the placebo group at 6 months (P = 0.002) and 12 months (P = 0.005). During the 6-month post-treatment period, no increased relapse rate or residual drug effect was observed. The side effect profile for Acamprosate was good compared with controls with only diarrhoea being reported more frequently (P <0.01). This study confirms the pharmacological efficacy of Acamprosate and its good acceptability. As an adjunct to psychotherapy, this study supports the inclusion of Acamprosate in a strategy for treating alcoholism.

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I think the answer would be - it reduces craving.

' dose dependent fashion -'  i don't think it's the correct answer

When u start Acomprosate u would start either 666mg tds  or

acoprosate 666mg od and 333mg bd depends on the body weight and age.We are not titratring the dose here.So how it could be dose dependent fashion.

correct me if i am wrong.

Thats a very good point terminal 5...

I dont know if the dose dependency of acamp has been tested in humans... But it has been very well established in Rats...

My arguement would be, the very fact that Acamp is given at a fixed dose of 1998mg  is because it is not effective at a lower dose... and hence dose dependent...

(like I said, I am not sure if there has been head to head studies with different doses in humans...)

But that said, it is touted to be an anticraving drug... (unless recent papers show that it really does not have any effect on craving)

my thoughts as well.c great minds think alike :lol:

:lol: :lol: :lol:

But I suspect my reasoning is wrong mp3... but I agree great minds do think alike... ;) ;) ;)

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I am not sure i have read somewhere ? spmm ,recent evidence does not support that it reduce craving????

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