Gabapentin Combined With Naltrexone for the Treatment of Alcohol Dependence

Abstract

Objective Naltrexone, an efficacious medication for alcohol dependence, does not work for everyone. Symptoms (e.g. insomnia, mood instability), most evident during early abstinence, might respond better to a different pharmacotherapy. Gabapentin may reduce these symptoms and early relapse. This clinical trial evaluated whether gabapentin, in conjunction with naltrexone, was better than naltrexone alone and/or placebo during the early drinking cessation phase (first six weeks) and whether this effect persisted. Method A total of 150 alcohol-dependent individuals randomly received sixteen weeks of naltrexone alone (50 mg/day [N= 50]), with gabapentin (up to 1200 mg/day [N=50] for the first six weeks), or double placebo (N= 50) while receiving medical management. Results During the first six weeks, the naltrexone/gabapentin group had 1) a longer delay to heavy drinking than the naltrexone-alone group (p =0.04) which was similar to the placebo group, 2) had less heavy drinking days than the naltrexone-alone group (p= 0.0002) which did worse than placebo, and 3) had less drinks/drinking day than the naltrexone-alone group (p=0.02) and the placebo group (p=0.01). These differences faded over the remaining study weeks. Poor sleep was associated with more drinking in the naltrexone-alone group, but not in the combined group, while an alcohol withdrawal history was associated with better response in the combined group. Conclusion The addition of gabapentin to naltrexone improved drinking outcomes over naltrexone alone during the first six weeks after cessation of drinking. This effect did not endure once gabapentin was discontinued. Future studies should evaluate gabapentin alone and over longer durations of treatment.

The Reasons for Heavy Drinking Questionnaire: Factor Structure and Validity in Alcohol-Dependent Adults Involved in Clinical Trials

“…Participants completed the RHDQ during a baseline visit before medication randomization. Study 1 evaluated the effects of naltrexone alone and in combination with gabapentin (Anton et al, 2011). Study 2 evaluated the effects of naltrexone alone and in combination with aripiprazole.…”

Novel Therapeutic Strategies for Alcohol and Drug Addiction: Focus on GABA, Ion Channels and Transcranial Magnetic Stimulation

“…However, the specificity of this effect is preliminary and needs further exploration as to validity and mechanism of action. Finally, a recent trial reported that the combination of gabapentin (up to 1200 mg/day) to naltrexone resulted in significantly improved drinking outcomes over naltrexone alone, and history of alcohol withdrawal was associated with better response in the naltrexonegabapentin group (Anton et al, 2011).…”

Dual Diagnosis of Traumatic Brain Injury and Alcohol Use Disorder: Characterizing Clinical and Neurobiological Underpinnings

“…Behavioral symptoms of alcohol withdrawal, particularly in early abstinence, include impulsivity, anxiety, irritability, dysphoria, insomnia, and impaired concentration [92]. These symptoms overlap with the emotional and cognitive dysfunction resulting from TBI as described above [93].…”