Hugh Myrick, MD, Robert Malcolm, MD, Patrick K. Randall, PhD, Elizabeth Boyle, MSW, Raymond F. Anton, MD, Howard C. Becker, PhD, and Carrie L. Randall, PhD
Some anticonvulsants ameliorate signs and symptoms of alcohol withdrawal, but have an unacceptable side effect burden. Among the advantages of using anticonvulsant agents in this capacity is their purported lack of interaction with alcohol that could increase psychomotor deficits, increase cognitive impairment, or increase intoxication. The aim of the current study was to evaluate alcohol use and symptom reduction of gabapentin as compared to lorazepam in the treatment of alcohol withdrawal in a double-blinded randomized clinical trial.
One hundred individuals seeking outpatient treatment of alcohol withdrawal with Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) ratings ≥10 were randomized to double-blind treatment with two doses of gabapentin (900 mg tapering to 600 mg or 1200 tapering to 800 mg) or lorazepam (6 mg tapering to 4 mg) for four days. Severity of alcohol withdrawal was measured by the CIWA-Ar on days 1-4 of treatment and on days 5, 7 and 12 post-treatment and alcohol use monitored by verbal report and breath alcohol levels.
CIWA-Ar scores decreased over time in all groups; high-dose gabapentin was statistically superior but clinically similar to lorazepam (p=0.009). During treatment, lorazepamtreated participants had higher probabilities of drinking on the first day of dose decrease (day 2) and the second day off medication (day 6) as compared to gabapentin-treated participants (p=. 0002). Post-treatment, gabapentin-treated participants had less probability of drinking during the follow-up post-treatment period (probability=.2 for 900 mg and probability=.3 for 1200mg) compared to the lorazepam-treated participants (probability=.55). The gabapentin groups also had less craving, anxiety, and sedation compared to lorazepam.
Gabapentin was well tolerated and effectively diminished the symptoms of alcohol withdrawal in our population especially at the higher target dose (1200mg) used in this study. Gabapentin reduced the probability of drinking during alcohol withdrawal and in the immediate post-withdrawal week as compared to lorazepam.
Keywords Gabapentin; Alcohol Dependence; Alcohol Withdrawal; Lorazepam