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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. 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). 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 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. 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. 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. 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: (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".) 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. 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: UpToDate • 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) . Gabapentinoids are commonly ingested in self-harm attempts and often misused for their sedative and euphoric properties. These medications can cause lethargy or agitation in overdose, increase risk of death combined with opioids, and manifest a withdrawal syndrome. 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. One trial conducted in an outpatient treatment center examined the efficacy of 28-day gabapentin treatment in reducing alcohol consumption and craving. Eligible subjects were randomized to placebo or gabapentin 300 mg twice-daily. 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. Gabapentin 400 mg four times a day was compared to placebo in 61 alcohol-withdrawing patients and throughout the 7-day trial was found to have no advantage over placebo in reducing amount of clomethiazole required to decrease symptoms of alcohol withdrawal. Objective: The current meta-analysis synthesizes previous findings on the effect of gabapentin on alcohol withdrawal and craving. Data sources: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, a search for relevant English-language literature published between January 1999 and February 2019 was conducted using PubMed and Google Scholar with the Electronic health records were reviewed to collect CIWA scores, alcohol withdrawal seizure and delirium tremens incidence, rates of conversions from gabapentin/baclofen to lorazepam, rates of transitions to a higher level of care, and readmission for AWS within 30 days.
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