Gabapentin Found to Work Best for Those With Severe Alcohol Withdrawal Syndrome

Gabapentin is effective at reducing heavy drinking and promoting abstinence among people with alcohol use disorder (AUD), especially those with strong withdrawal symptoms, reports a study published today in JAMA Internal Medicine.

Previous studies suggest that gabapentin can help reduce short-term symptoms of alcohol withdrawal syndrome, which can include irritability, anxiety, sweating, and insomnia. The research on gabapentin’s ability to promote long-term reductions in drinking has been mixed, however.

Raymond Anton, M.D., and colleagues at the Medical University of South Carolina enrolled 96 adults who met the DSM-5 diagnosis for AUD, including alcohol withdrawal. After three days of alcohol abstinence, the participants were randomly assigned to receive either gabapentin (starting at 300 mg/day and titrated up to 1,200 mg/day) or placebo pills for 16 weeks. Participants also received nine medical management sessions, consisting of 15- to 20-minute appointments with a medical professional during which they were assessed on daily drinking since their last visit.

At the end of the study, 27% of the participants taking gabapentin reported no heavy drinking days (defined as consuming five or more drinks a day for men, four or more for women) compared with 9% of the participants taking placebo. In addition, 21% of the gabapentin participants reported total abstinence during the study, compared with 4% of the participants in the placebo group. Reduced drinking was especially prominent among participants who had higher alcohol withdrawal scores at baseline. Participants with low withdrawal scores at baseline had similar outcomes regardless of whether they took gabapentin or placebo.

“The weight of the evidence now suggests that gabapentin might be most efficacious after the initiation of abstinence to sustain it and that it might work best in those with a history of more severe alcohol withdrawal symptoms,” Anton and colleagues wrote. “Armed with this knowledge, clinicians may have another alternative when choosing a medication to treat AUD and thereby encourage more patient participation in treatment with enhanced expectation of success.”

To read more on this topic, see the Psychiatric News article “APA Releases Practice Guideline for AUD Pharmacotherapy” and APA’s Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder.

(photo: iStock/blueclue)

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