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INTRODUCTION. Patients with alcohol use disorder may experience a withdrawal syndrome when they abruptly stop or sharply reduce consumption. Mild withdrawal symptoms can include anxiety, agitation, restlessness, insomnia, tremor, diaphoresis, palpitations, headache, and alcohol craving, and often loss of appetite, nausea, and vomiting. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499 to 500). Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Specify if: Individuals with alcohol use disorder may experience a withdrawal syndrome when they abruptly stop or sharply reduce consumption of alcohol. In some cases, these can progress to life threatening seizures or delirium tremens (DT). Individuals with alcohol use disorder may experience a withdrawal syndrome when they abruptly stop or sharply reduce consumption of alcohol. In some cases, these can progress to life threatening seizures or delirium tremens (DT). • The presence of significant alcohol withdrawal in the presence of an elevated ethanol level • A longer period (more than two days) between the last drink and the onset of withdrawal. The best predictor for clinically significant alcohol withdrawal is a score of 4 or higher on the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) . Gabapentin’s anxiolytic and sedative properties along with its overall safety profile suggest that it may be a viable adjuvant to lorazepam in the management of acute alcohol withdrawal. Gabapentin has been shown to be safe and effective for mild alcohol withdrawal but is not appropriate as mono-therapy for severe withdrawal owing to risk of seizures. During early abstinence, gabapentin may improve sleep, cravings, and mood—factors associated with relapse. UpToDate Anton RF, Latham P, Voronin K, et al. Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:728. Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Gabapentin is efficacious for the treatment of acute alcohol withdrawal symptoms 29, 30 and also provides short-term relapse prevention after medicated alcohol detoxification, 31 perhaps by an effect on sleep normalization. 32, 33 Post hoc analysis has shown effectiveness of treatment with gabapentin, in combination with flumazenil 34 or naltrex - DSM-5-TR diagnostic criteria for alcohol use disorder - First-line agents for alcohol use disorder; RELATED TOPICS. Alcohol use disorder: Pharmacologic management; Alcohol use disorder: Psychosocial management; Alcohol withdrawal: Ambulatory management; Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499 to 500). Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. Specify if: Anton RF, Latham P, Voronin K, et al. Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:728. Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Early initiation of high-dose gabapentin was associated with a significant reduction in benzodiazepine exposure, faster stabilization of alcohol withdrawal-related symptoms, and shorter hospital length of stay. UpToDate (See "Alcohol withdrawal: Ambulatory management" and "Alcohol use disorder: Treatment overview" and "Clinical manifestations and diagnosis of alcohol-associated steatosis and cirrhosis" and "Hematologic complications of alcohol use" and "Screening for unhealthy use of alcohol and other drugs in primary care".) Thus, gabapentin should only be used in mild alcohol withdrawal, including outpatient settings where benzodiazepines can’t be safely administered. Although future research is required to determine optimal dosing, at this point, it seems gabapentin 600 mg thrice-daily provides the best results. Conclusions and relevance: These data, combined with others, suggest gabapentin might be most efficacious in people with AUD and a history of alcohol withdrawal symptoms. Future studies should evaluate sleep changes and mood during early recovery as mediators of gabapentin efficacy. Gabapentin is effective at reducing drinking among people with alcohol use disorder (AUD) and strong withdrawal symptoms, according to a study published in JAMA Internal Medicine. Anton RF, Latham P, Voronin K, et al. Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:728. Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder.
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