Use of a Gabapentin Protocol for the Management of Alcohol Withdrawal: A Preliminary Experience Expanding From the Consultation-Liaison Psychiatry Service

Leung, Jonathan G.; Rakocevic, Daniela B.; Allen, Nicholas D.; Handler, Elliot M.; Perossa, Bruno A.; Borreggine, Kristin L.; Stark, Amy L.; Betcher, Hannah K.; Hosker, Daniel K.; Minton, Blaine A.; Braus, Benjamin R.; Dierkhising, Ross A.; Philbrick, Kemuel L.

doi:10.1016/j.psym.2018.03.002

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…Multiple studies and reviews have examined the efficacy and safety of gabapentin for alcohol withdrawal. 22,[56][57][58] A retrospective cohort study of 100 patients who presented to an ED found that those who received high-dose gabapentin (1800 mg/ day) during the first two days of hospital admission required a significantly lower total dose of benzodiazepines. 56 The gabapentin cohort also had both a significantly lower mean and maximum CIWA-Ar score on the third day of hospitalization.…”

Section: Benzodiazepinesmentioning

confidence: 99%

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<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Wolf

Curry

Nacht

et al. 2020

OAEM

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Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and lifethreatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients' AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.

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Section: Benzodiazepinesmentioning

confidence: 99%

“…In general, gabapentin appears particularly beneficial for mild AWS rather than more severe presentations. 58 Sample protocols utilizing gabapentin are presented in Table 3.…”

Section: Benzodiazepinesmentioning

confidence: 99%

<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Wolf

Curry

Nacht

et al. 2020

OAEM

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“…Before gabapentin is prescribed for alcohol withdrawal, potential benefi ts (reduction of withdrawal symptoms), side effects (sedation, fatigue), and risks (falls) should be discussed with the patient. 46 Patients should also be informed that benzodiazepines are the gold standard for alcohol withdrawal and that gabapentin is not effective for severe withdrawal. 46 For relapse prevention When initiating treatment for relapse prevention, the patient and the prescriber should agree on specifi c goals (eg, reduction of drinking, anxiety, and insomnia).…”

Section: For Alcohol Withdrawalmentioning

confidence: 99%

“…46 Patients should also be informed that benzodiazepines are the gold standard for alcohol withdrawal and that gabapentin is not effective for severe withdrawal. 46 For relapse prevention When initiating treatment for relapse prevention, the patient and the prescriber should agree on specifi c goals (eg, reduction of drinking, anxiety, and insomnia). 2,16 Ongoing monitoring is essential and includes assessing and documenting improvement with respect to these goals.…”

Section: For Alcohol Withdrawalmentioning

confidence: 99%

Gabapentin for alcohol use disorder: A good option, or cause for concern?

Modesto‐Lowe

Barron

Aronow

et al. 2019

CCJM

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P erceptions regarding the use of gabapentin for alcohol use disorder (AUD) have shifted over time. 1-4 Early on, the drug was deemed to be benign and effective. 4-6 But more and more, concerns are being raised about its recreational use to achieve euphoria, 7 and the drug is often misused by vulnerable populations, particularly those with opioid use disorder. 7-9 Given the large number of gabapentin prescriptions written off-label for AUD, it is incumbent on providers to understand how to prescribe it responsibly. 7-9 To that end, this article focuses on the benefi tsand concerns-of this treatment option. We describe the effects of gabapentin on the central nervous system and how it may mitigate alcohol withdrawal and increase the likelihood of abstinence. In addition, we review clinical trials that evaluated potential roles of gabapentin in AUD, discuss the drug's misuse potential, and suggest a framework for its appropriate use in AUD management. ■ ALCOHOL USE DISORDER IS COMMON AND SERIOUS AUD affects about 14% of US adults and represents a signifi cant health burden, 1 often with severe clinical and social implications. It manifests as compulsive drinking and loss of control despite adverse consequences on various life domains. 10 It is generally associated with cravings, tolerance, and withdrawal symptoms upon cessation. Alcohol withdrawal is characterized by tremors, anxiety, sweating, nausea, and tachycardia, and in severe cases, may involve hallucinations, seizures, and delirium tremens. Untreated, alcohol withdrawal can be fatal. 10

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“…We considered that analyzing the effects of gabapentinoids on both withdrawal and craving would provide insight into the mechanism of action of gabapentinoids. As with the effects on alcohol consumption, the effects of gabapentinoids on alcohol withdrawal and craving have been somewhat inconsistent and various outcome indicators have been used (Addolorato & Leggio, 2010; Becker, Myrick, & Veatch, 2006; Bonnet et al, 1999, 2003, 2010; Bozikas, Petrikis, Gamvrula, Savvidou, & Karavatos, 2002; Di Nicola et al, 2010; Forg et al, 2012; Guglielmo et al, 2012; Leung, Hall‐Flavin, Nelson, Schmidt, & Schak, 2015; Leung et al, 2018; Martinotti et al, 2008; Myrick et al, 2009; Oulis & Konstantakopoulos, 2012; Prince & Turpin, 2008; Voris, Smith, Rao, Thorne, & Flowers, 2003; Wilming, Alford, & Klaus, 2018). Some studies have also explored the effects of GBP and PGB on depression and insomnia in AUD patients (Malcolm, Myrick, Veatch, Boyle, & Randall, 2007; Mason et al, 2014; Mason, Quello, & Shadan, 2018; Wilming et al, 2018) and adverse reactions to these drugs (Di Nicola et al, 2010; Mason, Light, Williams, & Drobes, 2009; Rustembegovic, Sofic, Tahirovic, & Kundurovic, 2004; Voris et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Gabapentinoids for treatment of alcohol use disorder: A systematic review and meta‐analysis

Cheng

Huang

2020

Human Psychopharmacology

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Objective Gabapentin (GBP) and pregabalin (PGB) have been used to treat alcohol use disorder (AUD) and alcohol withdrawal, but with inconsistent results. In this meta‐analysis, we explored the effects of GBP/PGB treatment on AUD and their effects on withdrawal, craving, depression, and sleep disturbance in AUD patients. Methods We carried out a systematic review and meta‐analysis of randomized controlled trials comparing the effects of GBP/PGB on AUD with those of a placebo or control treatment. Electronic databases were searched for relevant articles published before September 2019. The primary outcome was defined as the efficacy measure on achieving abstinence or reducing alcohol consumption in a hierarchical order. We included 16 studies in our meta‐analysis. Results Overall, GBP had no significant benefit comparing to placebo or control treatment (Hedges' g = 0.0725, p = 0.6743). For specific alcohol‐related outcome, GBP had significant effect on percentage of heavy drink (Hedges' g = 0.5478, p = 0.0441) and alcohol withdrawal symptoms (Hedges' g = 0.2475, p = 0.0425). GBP/PGB did not have significant beneficial effect on craving, depressive symptoms, or sleep disturbance. Instability was shown in sensitivity analyses of some above results. Conclusions GBP may be helpful to reduce AUD patients' heavy drinking behavior and withdrawal, but more studies are needed for drawing conclusions.

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Use of a Gabapentin Protocol for the Management of Alcohol Withdrawal: A Preliminary Experience Expanding From the Consultation-Liaison Psychiatry Service

Cited by 17 publications

References 20 publications

<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Gabapentin for alcohol use disorder: A good option, or cause for concern?

Gabapentinoids for treatment of alcohol use disorder: A systematic review and meta‐analysis

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