Contraindications
Acamprosate is primarily removed by the kidneys and should not be given to people with severely impaired kidneys (creatinine clearance less than 30 mL/min). A dose reduction is suggested in those with moderately impaired kidneys (creatinine clearance between 30 mL/min and 50 mL/min). It is also contraindicated in those who have a strong allergic reaction to acamprosate calcium or any of its components. Adverse effects
The US label carries warnings about increases of suicidal behavior, major depressive disorder, and kidney failure.Adverse effects that caused people to stop taking the drug in clinical trials included diarrhea, nausea, depression, and anxiety.Potential adverse effects include headache, stomach pain, back pain, muscle pain, joint pain, chest pain, infections, flu-like symptoms, chills, heart palpitations, high blood pressure, fainting, vomiting, upset stomach, constipation, increased appetite, weight gain, edema, sleepiness, decreased sex drive, impotence, forgetfulness, abnormal thinking, abnormal vision, distorted sense of taste, tremors, runny nose, coughing, difficulty breathing, sore throat, bronchitis, and rashes. Pharmacology
Pharmacodynamics
The pharmacodynamics of acamprosate are complex and not fully understood; however, it is believed to act as an NMDA receptor antagonist and positive allosteric modulator of GABAA receptors.Its activity on those receptors is indirect, unlike that of most other agents used in this context. An inhibition of the GABA-B system is believed to cause indirect enhancement of GABAA receptors.
The newborn babys closed lids should be thoroughly cleansed and dried. If the cause is determined to be due to a blocked tear duct, gentle palpation between the eye and the nasal cavity may be used to clear the tear duct. If the tear duct is not cleared by the time the newborn is 1 year old, surgery may be required. Postnatal measures include:
Use of 1% tetracycline ointment, 0.5% erythromycin ointment, or 1% silver nitrate solution (Credés method) into the eyes of babies immediately after birth
Single injection of ceftriaxone IM or IV should be given to infants born to mothers with untreated gonococcal infection. Curative treatment as a rule, conjunctival cytology samples and culture sensitivity swabs should be taken before starting treatment. Chemical ophthalmia neonatorum is a self-limiting condition and does not require any treatment. Gonococcal ophthalmia neonatorum needs prompt treatment to prevent complications. Topical therapy should include:
Saline lavage hourly until the discharge is eliminated
Bacitracin eye ointment four times per day (because of resistant strains, topical penicillin therapy is not reliable, but in cases with proven penicillin susceptibility, penicillin drops 5000 to 10000 units per ml should be instilled every minute for half an hour, every five minutes for next half an hour, and then half-hourly until the infection is controlled.) If the cornea is involved, then atropine sulfate ointment should be applied.