4 Acamprosate Side Effects You Should Know About

Acamprosate is a prescription medication that helps treat alcohol use disorder (AUD). When paired with non-medication options, such as therapy and counseling, acamprosate is considered a first-choice medication for AUD.

Although it's usually well-tolerated, there are some acamprosate side effects to be aware of. If you’ve been prescribed this medication, it’s a good idea to know what to watch out for, and when you should contact your healthcare provider.

Good to know: Some acamprosate side effects are also symptoms of alcohol withdrawal. This includes nausea and mood changes. So when you stop drinking alcohol and start acamprosate, it can be hard to tell if the initial discomfort you’re experiencing is due to alcohol withdrawal or acamprosate. Luckily, mild symptoms should resolve on their own. More serious symptoms — such as seizures, mental confusion, and severe sweating — are signs of severe alcohol withdrawal. If you’re experiencing anything that feels severe, seek emergency care.

Acamprosate side effects at a glance

In general, acamprosate is tolerated well by most people. But like all medications, side effects can occur. Possible acamprosate side effects include:

• Diarrhea

• Trouble sleeping

• Nervousness or anxiety

• Low energy levels

More serious side effects of acamprosate include depression and suicidal thoughts or behavior. Below, we’ll go into more detail about four acamprosate side effects worth knowing about.

1. Diarrhea

Diarrhea is the most common acamprosate side effect. In studies, up to 17% of people experienced diarrhea when taking acamprosate. The risk is greater with higher doses.

Diarrhea from acamprosate usually improves over time. In the meantime, there are some things you can do at home to help manage your discomfort:

• Avoid foods that can worsen diarrhea. This includes fatty, fried, or spicy foods. It also includes foods that are high in fiber. Although a high-fiber diet is usually good for you, it can worsen diarrhea. Trying a bland diet for a day or two (like the BRAT diet) may be helpful. But don’t continue this for too long because you’ll miss out on nutrient-rich whole foods.

• Avoid your individual food triggers. If you know certain foods bother your stomach, be extra careful to avoid those foods while you have diarrhea.

• Consider over-the-counter (OTC) medications that treat diarrhea. Anti-diarrheal medications — such as loperamide (Imodium A-D) or bismuth subsalicylate (Pepto-Bismol) — may help. But these medications are only meant to be used short-term. And they’re not a good option for everyone, so talk to your healthcare provider before starting them.

• Consider taking a probiotic. Research shows that probiotics can help prevent diarrhea from occuring when you take antibiotics. But it’s not clear if it can prevent or treat diarrhea caused by other medications, like acamprosate. Talk to your healthcare provider about taking a probiotic if you’re interested in trying one.

If diarrhea persists, let your provider know. They might recommend stopping acamprosate or lowering your dose. They may also look into other possible causes.

Good to know: If you have diarrhea, it can make you dehydrated. So make sure to drink enough water or other liquids (about 8 oz for every loose bowel movement) to stay hydrated.

2. Gas

Acamprosate can cause gas or bloating. Like diarrhea, this usually resolves on its own. But there are some things you can do in the meantime to minimize gas:

• Drink plain water and avoid carbonated beverages

• Avoid certain foods that can make gas worse (like dairy and FODMAPs)

• Eat smaller but more frequent meals

• Eat slower and while you’re sitting

If these tips don't work, OTC medications may help. Some examples include medications or supplements containing activated charcoal, simethicone, and alpha-galactosidase (Beano). But these medications don’t work for everyone, so talk to your healthcare provider about whether an OTC product is a good option for you.

3. Nausa

Nausea is a possible side effect of many medications, including acamprosate. If you become nauseated after taking acamprosate, a few tips that may help include:

• Stay hydrated, because dehydration can worsen nausea

• Eat smaller, more frequent meals

• Avoid spicy and fatty foods

• Try ginger or peppermint products, which may reduce nausea

If nausea continues, talk to your healthcare provider or pharmacist about OTC nausea medications. But nausea that doesn’t improve may be a sign that acamprosate isn’t the best medication for you. So if it continues beyond a few days, contact your provider and they’ll help you decide what to do next.

4. Suicidal thoughts and behaviors

People with AUD have a higher risk of depression and suicidal thoughts or behaviors. Taking acamprosate is also associated with an increased risk of suicidal thoughts and behaviors. You may be more likely to experience this if you’ve relapsed to alcohol while taking acamprosate. Regardless, if you notice any mood changes after starting acamprosate, let your healthcare provider know.

It’s a good idea to let close friends and family know that you’re taking acamprosate. They can help monitor for changes in your mood and be ready to support you if you relapse.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

When should you contact your healthcare provider about acamprosate side effects?

Many acamprosate side effects are mild. Diarrhea, gas, and nausea can usually be managed at home. But if you’re experiencing these side effects and they’re interfering with your daily life or don’t go away after a few days to weeks, talk to your pharmacist or healthcare provider about what to do next.

However, if you have worsening depression or suicidal thoughts or behaviors, you’ll want to contact your healthcare provider immediately or seek emergency care.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.