Gabapentin as a Treatment for Alcohol Use Disorder and Alcohol Withdrawal Symptoms

Pharmacological options for treatment of alcohol use disorder (AUD) are limited. Gabapentin may improve alcohol withdrawal symptoms through its hypothesized action on GABA and glutamate activity. In this randomized trial, researchers assessed the effects of gabapentin on alcohol consumption over 16 weeks among 96 people with AUD and withdrawal symptoms* who were abstinent at baseline (those with acute withdrawal symptoms** were excluded). Participants were randomized to receive gabapentin (up to 1200 mg/day) or placebo. All also received 9 brief educational and supportive sessions.

• At follow-up, 27% of participants receiving gabapentin had no heavy drinking days, compared with 9% of participants receiving placebo. There were also more people with total abstinence in the gabapentin group (18%), compared with placebo (4%).
• In secondary analyses, gabapentin showed an effect only among participants with high alcohol withdrawal symptoms, compared with those with low withdrawal symptoms (based on median split of alcohol withdrawal symptoms at baseline).
• Participants in the gabapentin group reported more dizziness compared with the placebo group.
• Overall, 30% of participants in the gabapentin group and 39% in the placebo group did not complete treatment, although they were included in the final analysis.

* Measured via the modified Alcohol Withdrawal Symptoms Checklist (AWSC).

** Defined as a Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) score of ≥10.

Comments: This study provides evidence that gabapentin may be useful to treat AUD among people with significant alcohol withdrawal symptoms, but these results should be replicated since people with acute withdrawal symptoms were excluded. Potential efficacy should be balanced with the risk of misuse and the risk for overdose death among people who use other drugs.

Nicolas Bertholet, MD, MSc

Reference: 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(5):1–9.