Gabapentin Versus Phenobarbital for Alcohol Withdrawal

Animal studies and several small, uncontrolled clinical trials show that the anticonvulsant gabapentin may reduce alcohol withdrawal symptoms. In this controlled study, researchers assessed gabapentin’s efficacy among inpatients on a detoxification unit who had moderate or more severe alcohol withdrawal. Twenty-seven subjects were randomized to receive either oral gabapentin (2400 mg on day 1 tapered to 600 mg on day 4) or oral phenobarbital (240 mg on day 1 tapered to 60 mg on day 4). The severity of alcohol withdrawal was measured by the Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) and the Alcohol Craving scale.

• Mean CIWA-Ar and Alcohol Craving scores decreased at similar rates in both treatment groups.
• Although higher in the gabapentin group, the proportion of subjects needing “rescue” phenobarbital for breakthrough signs and symptoms of withdrawal did not significantly differ between treatment groups (57% of the gabapentin group; 38% of the phenobarbital group).
• The proportion who failed to complete the trial also did not significantly differ between the groups (29% of the gabapentin group; 38% of the phenobarbital group).
• No subject had an alcohol withdrawal seizure or alcohol withdrawal delirium.

Comments:

This small study shows that gabapentin may be as effective as phenobarbital for reducing the signs and symptoms of alcohol withdrawal. Gabapentin, however, has been neither shown to prevent alcohol withdrawal seizures and delirium nor compared directly with benzodiazepines. Until these concerns are researched, benzodiazepines should remain the drug class of choice for alcohol withdrawal.

Kevin L. Kraemer, MD, MSc

Reference:

Mariani JJ, Rosenthal RN, Tross S, et al. A randomized, open-label, controlled trial of gabapentin and phenobarbital in the treatment of alcohol withdrawal. Am J Addict. 2006;15(1):76–84.