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Neurocognitive performance, alcohol withdrawal, and effects of a combination of flumazenil and gabapentin in alcohol dependence.
Alcohol Clin Exp Res. 2011 Nov; 35(11):2030-8.AC

Abstract

BACKGROUND

Among some alcohol-dependent individuals, early alcohol abstinence is marked by alcohol withdrawal (AW), a phenomenon mediated by GABA and glutamate signaling. We previously reported that a combination of 2 medications that affect GABA and glutamate tone, gabapentin and flumazenil, more effectively reduced drinking among individuals with higher pretreatment AW (Anton et al., 2009). This study evaluated whether this finding is related to changes in neurocognitive performance, which is also affected by cortical GABA and glutamate tone.

METHODS

Neurocognitive performance was assessed at baseline and twice during the first week of treatment among 60 alcohol-dependent participants in the previously published clinical trial.

RESULTS

AW was associated with poorer baseline performance on 4 of 8 measures, and individuals with higher baseline AW who received the gabapentin and flumazenil combination demonstrated greater improvement on a measure of response inhibition than those with lower AW or those who received a combination of placebos. Improvement in response inhibition during the first week and medication group interacted in their effect on subsequent drinking, such that improvement predicted greater abstinence only among individuals who received gabapentin and flumazenil. Improvement on other neurocognitive measures was neither differentially impacted by medication or baseline AW nor related to subsequent drinking.

CONCLUSIONS

Taken together, these data suggest that acute AW accounts for a small proportion of variance in neurocognitive performance, that gabapentin and flumazenil slightly improve response inhibition during early abstinence, and that such improvement may somewhat reduce later drinking. However, these medications may not affect other neurocognitive domains.

Authors+Show Affiliations

Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, South Carolina 29425, USA. schacht@musc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21631542

Citation

Schacht, Joseph P., et al. "Neurocognitive Performance, Alcohol Withdrawal, and Effects of a Combination of Flumazenil and Gabapentin in Alcohol Dependence." Alcoholism, Clinical and Experimental Research, vol. 35, no. 11, 2011, pp. 2030-8.
Schacht JP, Randall PK, Waid LR, et al. Neurocognitive performance, alcohol withdrawal, and effects of a combination of flumazenil and gabapentin in alcohol dependence. Alcohol Clin Exp Res. 2011;35(11):2030-8.
Schacht, J. P., Randall, P. K., Waid, L. R., Baros, A. M., Latham, P. K., Wright, T. M., Myrick, H., & Anton, R. F. (2011). Neurocognitive performance, alcohol withdrawal, and effects of a combination of flumazenil and gabapentin in alcohol dependence. Alcoholism, Clinical and Experimental Research, 35(11), 2030-8. https://doi.org/10.1111/j.1530-0277.2011.01554.x
Schacht JP, et al. Neurocognitive Performance, Alcohol Withdrawal, and Effects of a Combination of Flumazenil and Gabapentin in Alcohol Dependence. Alcohol Clin Exp Res. 2011;35(11):2030-8. PubMed PMID: 21631542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurocognitive performance, alcohol withdrawal, and effects of a combination of flumazenil and gabapentin in alcohol dependence. AU - Schacht,Joseph P, AU - Randall,Patrick K, AU - Waid,L R, AU - Baros,Alicia M, AU - Latham,Patricia K, AU - Wright,Tara M, AU - Myrick,Hugh, AU - Anton,Raymond F, Y1 - 2011/06/01/ PY - 2011/6/3/entrez PY - 2011/6/3/pubmed PY - 2012/3/27/medline SP - 2030 EP - 8 JF - Alcoholism, clinical and experimental research JO - Alcohol Clin Exp Res VL - 35 IS - 11 N2 - BACKGROUND: Among some alcohol-dependent individuals, early alcohol abstinence is marked by alcohol withdrawal (AW), a phenomenon mediated by GABA and glutamate signaling. We previously reported that a combination of 2 medications that affect GABA and glutamate tone, gabapentin and flumazenil, more effectively reduced drinking among individuals with higher pretreatment AW (Anton et al., 2009). This study evaluated whether this finding is related to changes in neurocognitive performance, which is also affected by cortical GABA and glutamate tone. METHODS: Neurocognitive performance was assessed at baseline and twice during the first week of treatment among 60 alcohol-dependent participants in the previously published clinical trial. RESULTS: AW was associated with poorer baseline performance on 4 of 8 measures, and individuals with higher baseline AW who received the gabapentin and flumazenil combination demonstrated greater improvement on a measure of response inhibition than those with lower AW or those who received a combination of placebos. Improvement in response inhibition during the first week and medication group interacted in their effect on subsequent drinking, such that improvement predicted greater abstinence only among individuals who received gabapentin and flumazenil. Improvement on other neurocognitive measures was neither differentially impacted by medication or baseline AW nor related to subsequent drinking. CONCLUSIONS: Taken together, these data suggest that acute AW accounts for a small proportion of variance in neurocognitive performance, that gabapentin and flumazenil slightly improve response inhibition during early abstinence, and that such improvement may somewhat reduce later drinking. However, these medications may not affect other neurocognitive domains. SN - 1530-0277 UR - https://www.unboundmedicine.com/medline/citation/21631542/Neurocognitive_performance_alcohol_withdrawal_and_effects_of_a_combination_of_flumazenil_and_gabapentin_in_alcohol_dependence_ L2 - https://doi.org/10.1111/j.1530-0277.2011.01554.x DB - PRIME DP - Unbound Medicine ER -