Background: Up to 30 million people in the United States meet criteria for alcohol use disorder. Gabapentin addresses symptoms of protracted withdrawal such as insomnia, irritability, difficulty with attention, dysphoria, and anxiety. It does that by acting on voltage-gated calcium channels and, in turn, influencing GABA and glutamate tone and activity.
Dr. Padmaja Gaddam
Study design: Double-blind, placebo-controlled, randomized clinical trial.
Settings: Academic ambulatory setting at the Medical University of South Carolina.
Synopsis: A total of 96 community-recruited participants were randomly assigned to gabapentin and placebo arm then treated and followed for a total of 16 weeks. The gabapentin arm received gradual increments of gabapentin reaching up to 1,200 mg/day by day 5. The control group received placebo in blister packs. Individuals in the gabapentin arm, compared with those in the placebo arm, showed 18.6% (P = .02) more no heavy–drinking days, with a number needed to treat (NNT) of 5.4, and 13.8% (P = .04) more total abstinence days, with an NNT of 6.2. The prestudy high–alcohol withdrawal group in particular had significantly less relapse to heavy drinking (P = .02; NNT, 3.1) and more total abstinence (P = .03; NNT, 2.7) when treated with gabapentin.
A couple of study limitations were a significant noncompletion rate (30% in gabapentin arm and 39% in the placebo arm) and self-reported alcohol withdrawal symptoms prior to entry into the study.
Bottom line: Gabapentin helps in reducing drinking and maintaining alcohol abstinence in individuals with alcohol use disorder, especially those with high–alcohol withdrawal symptoms.
Citation: Anton RF et al. Efficacy of gabapentin for the treatment of alcohol use disorder in patients with alcohol withdrawal symptoms: A randomized clinical trial. JAMA Intern Med. 2020 Mar 9;180(5):728-36.
Dr. Gaddam is a hospitalist and assistant professor of medicine at UK HealthCare, Lexington, Ky.
