Categories: Medications and research
I haven’t written much about Campral, an anti-craving medication approved by the FDA in July, 2004 for treatment of alcohol dependence. It’s been prescribed in Europe, Canada, Australia and other countries and is growing in popularity in the US. We get a lot of questions about Campral at our discussion board as members prepare to approach their docs. They want to know: does it work? What are the side effects? How does it compare to other meds? Does it take long to kick in?
Here are a few observations I’ve made from MWO patients and members who have shared their experience:
- At this time, it’s generally easier to get a prescription for Campral than other anti-craving meds. Topamax requires off-label prescribing and some physicians are simply uncomfortable doing that. Vivitrol (injectable naltrexone) hit the market only recently and many doctors don’t know about it. Oral naltrexone (ReVia) doesn’t seem to be prescribed very much for some reason.
- Campral is well suited for those who plan to pursue complete abstinence from alcohol and haven’t had anything to drink for at least a few days.
- If you begin drinking while on it, Campral loses its efficacy pretty quickly.
- Patients sometimes complain of diarrhea, gas, and stomach discomfort when taking Campral. This side effect is said to be dose specific.
- Campral kicks in fairly soon for most people.
- Many patients find Campral quite effective. One clinical trial suggested people who took Campral were two or three times more likely to achieve abstinence a full year later than those who took a placebo.
- Others say they were not able to be compliant while on Campral and found other medications (usually Topamax) more effective. Some research supports these findings, however, there are differing views within research circles about the study design in some of the clinical trials.
- Side effects are often considered less harsh for Campral than Topamax.
- People who do drink while on Campral report getting drunk faster and feeling more hung over the next day.
- Campral can be used in combination with naltrexone.
- Like other anti-craving medications, Campral is most effective if used in conjunction with counseling and/or support. Patients who adopt multiple strategies tend to have greater long-term success.
So just how does Campral work?
According to manufacturer Forest Labs’ website, “Campral is thought to restore the normal brain balance, which has been disturbed in someone who is alcohol dependent.”
Hmmm. I don’t know if that’s terribly helpful, but I would certainly agree that our brains are disturbed once we’ve become alcohol dependent.
To be more specific, Campral targets and helps restore balance in two important neurotransmitters: glutamate and GABA. Glutamate is an excitatory transmitter and GABA is inhibitory. They have a see-saw type of relationship. GABA and glutamate receptors are also involved in the reward centers of the forebrain and are responsible for creating a system of positive reinforcement. But when a person chronically overdrinks, as we do, it depletes GABA functioning and results in a hyperexcitable glutamate system.
Drinkers feel great while they’re drinking. But the short-term buzz eventually ends up throwing the entire system off. And when alcohol is removed from the equation, the brain is left with way too much glutamate activity. This causes discomfort, anxiety and eventually an endless craving for alcohol.
Enter Campral, which helps restore the GABA-glutamate equilibrium by acting specifically on receptor sites tied to the alcohol reward signaling center. Or, as Forest Lab explains, again at third grade level, it “makes it easier for people not to drink.” Got it.
Campral is prescribed in two 333 mg. time-release tablets, taken three times a day with food or on an empty stomach. It should be used with caution if you have kidney problems and will not be prescribed if you have severe kidney disease. The medication cost about $150 a month. The package insert is here if you like reading the teeny weeny print.
By the way, if you have questions for those currently taking Campral, be sure to visit our online community. I’m not plugging our message board, but I think you’ll find some really good info because many of our members have tried a couple of different meds, including Campral, and they’re very generous about sharing their experience. You can simply enter the term “Campral” in the search field and you’ll find dozens of posts with lots of rich info, as well.
Do keep in mind that anti-craving medications target different brain receptors and how they work depends on a number of variables. So you won’t really know until you get started how effective they will be for you.
But there’s no time like the present to begin. Who knows, Campral may be just be what your doctor should order.