High‐Dose Gabapentin for the Treatment of Severe Alcohol Withdrawal Syndrome: A Retrospective Cohort Analysis

Abstract

STUDY OBJECTIVE Gabapentin has been proved to be beneficial in promoting abstinence, decreasing alcohol cravings, and improving mood and sleep quality when given at higher doses; however, data are limited regarding the efficacy and safety of using high-dose gabapentin as part of the treatment of alcohol withdrawal syndrome (AWS). The aim of this study was to evaluate the impact of highdose gabapentin on benzodiazepine requirements, alcohol withdrawal symptoms, and hospital length of stay in patients hospitalized with AWS. DESIGN Retrospective cohort study. SETTING Large academic medical center. PATIENTS All adults presenting to the emergency department between January 2015 and April 2018 with a diagnosis of severe AWS (Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised [CIWA-Ar] score ≥ 15) and prescribed the institution's alcohol withdrawal agitated delirium protocol were eligible for inclusion in the study. Of these, 50 patients who received high-dose gabapentin (≥ 1800 mg/day) in the first 48 hours of hospital admission (treatment group) were propensity score-matched to 50 patients who did not receive gabapentin (control group). MEASUREMENTS AND MAIN RESULTS Patients who received high-dose gabapentin required a significantly lower overall amount of benzodiazepines (mean AE SD 109.5 AE 53.4 mg vs 88.5 AE 35.6 mg [lorazepam equivalents], p=0.023) and had a significantly lower mean CIWA-Ar score (10.1 AE 4.7 vs 7.7 AE 3.9, p=0.010) and maximum CIWA-Ar score (16.0 AE 7.0 vs 12.6 AE 6.1, p=0.016) on day 3 of hospitalization. The high-dose gabapentin regimen was well tolerated, without an increased risk of oversedation, compared with the control group (Richmond Agitation-Sedation Scale score < À1: 34% in the treatment group vs 20% in the control group, p=0.115). Patients receiving high-dose gabapentin had a shorter length of hospital stay (7.4 AE 4.0 days vs 6.0 AE 2.6 days, p=0.034) and

Retrospective Analysis of Gabapentin for Alcohol Withdrawal in the Hospital Setting: The Mayo Clinic Experience

“…A retrospective review of 50 patients who received at least 1800 mg per day of gabapentin in the first 48 hours of AWS compared with 50 propensity-matched patients who received benzodiazepines found that the gabapentin group required lower benzodiazepine doses and had a shorter LOS. 15 In contrast, 3 other retrospective studies [16][17][18] used gabapentin to augment AWS management and found no reduction in benzodiazepine use. However, patients in Vadiei et al 18 and Nichols et al 17 received lower mean doses of gabapentin per day compared with Levine et al 15 (1000 and 1200 mg per day, respectively).…”

“…15 In contrast, 3 other retrospective studies [16][17][18] used gabapentin to augment AWS management and found no reduction in benzodiazepine use. However, patients in Vadiei et al 18 and Nichols et al 17 received lower mean doses of gabapentin per day compared with Levine et al 15 (1000 and 1200 mg per day, respectively). Those studied by Anduluz et al 16 received a total of 2100 mg of gabapentin on day 1 and 1800 mg on day 2.…”

“…There are limited data available regarding the use of gabapentin for AWS, particularly in the inpatient setting. When gabapentin is added to CIWA-directed benzodiazepine therapy, some studies have shown reduced benzodiazepine use and reduced LOS, 6 , 15 whereas others have not. 16 , 17 , 18 Even fewer studies have analyzed gabapentin monotherapy for AWS.…”

Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement

“…Similarly, studies evaluating gabapentin as a monotherapy or adjunctive therapy to benzodiazepines have shown inconsistent benefits ( 268 – 270 ). In one retrospective study, the use of high-dose gabapentin was associated with reduced hospital length of stay compared to standard-of-care treatment ( 269 ). Data on the use of pregabalin suggest no difference in clinical outcomes compared to placebo ( 271 ).…”

Drug Screening and Drug Repositioning as Promising Therapeutic Approaches for Spinal Muscular Atrophy Treatment

“…Likewise, Gabapentin (Neurontin), a FDA-approved drug whit a molecular structure similar to GABA, acts by inhibiting calcium channels. Gabapentin is used for the treatment of different forms of neuropathic pain, for anxiety disorders and alcoholism (Field et al, 1997;Caraceni et al, 2004;Pfizer Inc., 2009;Moore et al, 2011;Levine et al, 2019). Considering the neuroprotective effect of gabapentin in nerve damage-induced chronic neuropathic pain (Wiffen et al, 2017), two different clinical trials were conducted enrolling SMA type II and III patients (Miller et al, 2001;Merlini et al, 2003).…”