Is acamprosate ever used in clinical settings for benzo withdrawal?

[birchswing]

I recently learned about a drug called acamprosate that reduces glutamate hyperexcitability during alcohol and benzodiazepine withdrawal. I've read about it being used in clinical practice with alcoholics but not in benzodiazepine withdrawal. Is it ever used for benzodiazepine withdrawal (beyond research)?

---

Members don't see this ad.

 

[F0nzie]

Nope. Although the mechanism makes sense by enhancing GABA and blocking NMDA we use it for the stabilizing properties rather than treatment for moderate to severe withdrawal. Consider the seizure risk of not using a benzodiazepine for withdrawal.

 

[F0nzie]

If you're interested in thinking out of the box consider looking up some of the Carbamazepine studies for ETOH withdrawal. Phenobarbital is another option. Pro of phenobarbital is you can quickly establish their tolerance if they are a poor historian or have erratic use. Need a controlled setting though. Benzodiazepines are still the standard.

 

[birchswing]

Sorry, I maybe worded my question wrong. I was asking about the use of acamprosate in benzodiazepine withdrawal (not alcohol withdrawal). I know benzodiazepines are used for alcohol withdrawal, but I was asking about withdrawal from chronic use of benzodiazepines.

I probably shouldn't have mentioned alcohol in my question as it confused the matter. The only reason I mentioned alcohol was that I have seen acamprosate used in alcoholic patients in a clinical setting, but the only information I found on the web about using acamprosate in patients with chronic benzodiazepine use was research studies. I didn't see examples of psychiatrists prescribing acamprosate to chronic benzodiazepine users as part of withdrawal, and I was wondering if it's ever done.

 

[F0nzie]

ETOH and benzo withdrawals are similar. We use acamprosate as a maintenance drug for ETOH. And it does not prevent ETOH withdrawal. There is no evidence that it prevents benzodiazepine withdrawal either. It may reduce anxiety during withdrawal but not really useful to treat withdrawal itself.

 

[F0nzie]

Unless it is a mild withdrawal that could run its course safely I doubt anybody would prescribe acamprosate.

 

[birchswing]

Thanks very much!

 

[slappy]

birchswing, please consider adding a tag under your name on the left indicating that you are a patient, and not a provider.

 

[birchswing]

birchswing, please consider adding a tag under your name on the left indicating that you are a patient, and not a provider.

Ahh yes, I usually add my disclaimer, forgot to. Will do.

 

[vistaril]

ETOH and benzo withdrawals are similar. We use acamprosate as a maintenance drug for ETOH. And it does not prevent ETOH withdrawal. There is no evidence that it prevents benzodiazepine withdrawal either.QUOTE]

An even better question- Is there decent evidence it does anything for maintenance in etoh treatment?

 

[F0nzie]

The evidence is not all that compelling

 

[shan564]

In terms of exotic treatments for EtOH/benzo withdrawal, I've seen some real and anecdotal evidence for Depakote and gabapentin.

I think the OP is confusing "withdrawal" with the idea of maintenance for an addiction. Acamprosate is not used for acute alcohol withdrawal, it's used to reduce long-term cravings for alcohol after the withdrawal period is over. During the acute withdrawal period, the risk of seizures is too high to use anything too exotic.

 

[birchswing]

In terms of exotic treatments for EtOH/benzo withdrawal, I've seen some real and anecdotal evidence for Depakote and gabapentin.

I think the OP is confusing "withdrawal" with the idea of maintenance for an addiction. Acamprosate is not used for acute alcohol withdrawal, it's used to reduce long-term cravings for alcohol after the withdrawal period is over. During the acute withdrawal period, the risk of seizures is too high to use anything too exotic.

I understand the difference. I was just of the belief through informal research that after chronic benzodiazepine use, there is a downregulation of benodiazepine receptors and an upregulation of glutamate receptors. I read that acamprosate could attenuate glutamate receptors. My thinking was that during a benzodiazepine withdrawal (meaning a taper) if some of the withdrawal symptoms are caused by glutamate hyperexcitability, acamprosate might help with the symptoms, not that it would be a means to withdrawal, just curious if it's used to help with symptoms of withdrawal. I understand that in the case of benzodiazepine withdrawal, the method itself is a slow taper of benzodiazepines. I am less familiar with alcohol withdrawal, but I understand that it involves transitioning to benzodiazepines and then tapering those. I have heard of gabapentin as you mentioned, had not heard of depakote for that.

 

[OldPsychDoc]

It's probably of low risk, though. I'd probably try it with a motivated patient if they came to me with the idea.

 

[shan564]

It's probably of low risk, though. I'd probably try it with a motivated patient if they came to me with the idea.

+1.

 

[notdeadyet]

I'd go with gabapentin first.


Sent from my iPhone using Tapatalk

 

[birchswing]

I'd go with gabapentin first.


Sent from my iPhone using Tapatalk

I know Lyrica is supposed to a more potent successor to gabapentin. I read in Europe that is now the first line treatment for anxiety. Which of the two is less addicting?

 

[michaelrack]

In terms of exotic treatments for EtOH/benzo withdrawal, I've seen some real and anecdotal evidence for Depakote and gabapentin.

I think the OP is confusing "withdrawal" with the idea of maintenance for an addiction. Acamprosate is not used for acute alcohol withdrawal, it's used to reduce long-term cravings for alcohol after the withdrawal period is over. During the acute withdrawal period, the risk of seizures is too high to use anything too exotic.

Is there any usefulness for acamprosate to reduce long-term cravings for benzo's after the withdrawal period is over (for persons with benzo dependence)