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A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal.
Alcohol Clin Exp Res. 2009 Sep; 33(9):1582-8.AC

Abstract

INTRODUCTION

Some anticonvulsants ameliorate signs and symptoms of alcohol withdrawal, but have an unacceptable side effect burden. Among the advantages of using anticonvulsant agents in this capacity is their purported lack of interaction with alcohol that could increase psychomotor deficits, increase cognitive impairment, or increase intoxication. The aim of this study was to evaluate alcohol use and symptom reduction of gabapentin when compared with lorazepam in the treatment of alcohol withdrawal in a double-blinded randomized clinical trial.

METHODS

One hundred individuals seeking outpatient treatment of alcohol withdrawal with Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) ratings > or =10 were randomized to double-blind treatment with 2 doses of gabapentin (900 mg tapering to 600 mg or 1200 tapering to 800 mg) or lorazepam (6 mg tapering to 4 mg) for 4 days. Severity of alcohol withdrawal was measured by the CIWA-Ar on days 1 to 4 of treatment and on days 5, 7, and 12 post-treatment and alcohol use monitored by verbal report and breath alcohol levels.

RESULTS

CIWA-Ar scores decreased over time in all groups; high-dose gabapentin was statistically superior but clinically similar to lorazepam (p = 0.009). During treatment, lorazepam-treated participants had higher probabilities of drinking on the first day of dose decrease (day 2) and the second day off medication (day 6) compared to gabapentin-treated participants (p = 0.0002). Post-treatment, gabapentin-treated participants had less probability of drinking during the follow-up post-treatment period (p = 0.2 for 900 mg and p = 0.3 for 1200 mg) compared to the lorazepam-treated participants (p = 0.55). The gabapentin groups also had less craving, anxiety, and sedation compared to lorazepam.

CONCLUSIONS

Gabapentin was well tolerated and effectively diminished the symptoms of alcohol withdrawal in our population especially at the higher target dose (1200 mg) used in this study. Gabapentin reduced the probability of drinking during alcohol withdrawal and in the immediate postwithdrawal week compared to lorazepam.

Authors+Show Affiliations

Ralph H Johnson Department of Veterans Affairs Medical Center, Research and Development Service, Charleston, SC, USA. myrickh@musc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

19485969

Citation

Myrick, Hugh, et al. "A Double-blind Trial of Gabapentin Versus Lorazepam in the Treatment of Alcohol Withdrawal." Alcoholism, Clinical and Experimental Research, vol. 33, no. 9, 2009, pp. 1582-8.
Myrick H, Malcolm R, Randall PK, et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009;33(9):1582-8.
Myrick, H., Malcolm, R., Randall, P. K., Boyle, E., Anton, R. F., Becker, H. C., & Randall, C. L. (2009). A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcoholism, Clinical and Experimental Research, 33(9), 1582-8. https://doi.org/10.1111/j.1530-0277.2009.00986.x
Myrick H, et al. A Double-blind Trial of Gabapentin Versus Lorazepam in the Treatment of Alcohol Withdrawal. Alcohol Clin Exp Res. 2009;33(9):1582-8. PubMed PMID: 19485969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. AU - Myrick,Hugh, AU - Malcolm,Robert, AU - Randall,Patrick K, AU - Boyle,Elizabeth, AU - Anton,Raymond F, AU - Becker,Howard C, AU - Randall,Carrie L, Y1 - 2009/05/26/ PY - 2009/6/3/entrez PY - 2009/6/3/pubmed PY - 2009/11/17/medline SP - 1582 EP - 8 JF - Alcoholism, clinical and experimental research JO - Alcohol Clin Exp Res VL - 33 IS - 9 N2 - INTRODUCTION: Some anticonvulsants ameliorate signs and symptoms of alcohol withdrawal, but have an unacceptable side effect burden. Among the advantages of using anticonvulsant agents in this capacity is their purported lack of interaction with alcohol that could increase psychomotor deficits, increase cognitive impairment, or increase intoxication. The aim of this study was to evaluate alcohol use and symptom reduction of gabapentin when compared with lorazepam in the treatment of alcohol withdrawal in a double-blinded randomized clinical trial. METHODS: One hundred individuals seeking outpatient treatment of alcohol withdrawal with Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) ratings > or =10 were randomized to double-blind treatment with 2 doses of gabapentin (900 mg tapering to 600 mg or 1200 tapering to 800 mg) or lorazepam (6 mg tapering to 4 mg) for 4 days. Severity of alcohol withdrawal was measured by the CIWA-Ar on days 1 to 4 of treatment and on days 5, 7, and 12 post-treatment and alcohol use monitored by verbal report and breath alcohol levels. RESULTS: CIWA-Ar scores decreased over time in all groups; high-dose gabapentin was statistically superior but clinically similar to lorazepam (p = 0.009). During treatment, lorazepam-treated participants had higher probabilities of drinking on the first day of dose decrease (day 2) and the second day off medication (day 6) compared to gabapentin-treated participants (p = 0.0002). Post-treatment, gabapentin-treated participants had less probability of drinking during the follow-up post-treatment period (p = 0.2 for 900 mg and p = 0.3 for 1200 mg) compared to the lorazepam-treated participants (p = 0.55). The gabapentin groups also had less craving, anxiety, and sedation compared to lorazepam. CONCLUSIONS: Gabapentin was well tolerated and effectively diminished the symptoms of alcohol withdrawal in our population especially at the higher target dose (1200 mg) used in this study. Gabapentin reduced the probability of drinking during alcohol withdrawal and in the immediate postwithdrawal week compared to lorazepam. SN - 1530-0277 UR - https://www.unboundmedicine.com/medline/citation/19485969/A_double_blind_trial_of_gabapentin_versus_lorazepam_in_the_treatment_of_alcohol_withdrawal_ L2 - https://doi.org/10.1111/j.1530-0277.2009.00986.x DB - PRIME DP - Unbound Medicine ER -