Researchers hypothesized that adding gabapentin early in naltrexone treatment might improve longer term outcomes by ameliorating insomnia, irritability, and withdrawal craving. They randomly assigned 150 patients with alcohol dependence to 1 of 3 groups: naltrexone* plus gabapentin† (NG), naltrexone plus placebo (NP), or double placebo (PP). All subjects received an average of 10–11 sessions of combined behavioral intervention therapy over the course of the 16-week study.
- There was no difference in completion rates between the 3 arms (approximately 85%).
- During the first 6 weeks, the NG group had a longer time to relapse and fewer drinks per drinking day than the other 2 groups; however, the percentage of heavy drinking days was similar to the PP group.
- Naltrexone alone was not better than placebo for any drinking outcome.
- There were no differences between groups in Obsessive Compulsive Drinking Scale scores, but the NG group reported significantly better sleep than the other 2 groups.
- After gabapentin was stopped (weeks 7–16), there were no significant differences between the 3 arms for any drinking outcome.
*Dose of 50 mg daily for 16 weeks.
†Titrated up to a dose of 1200 mg daily for the first 6 weeks.
This study failed to confirm the hypothesis that prescribing gabapentin during the first 6 weeks of naltrexone treatment would improve longer term outcomes. Moreover, naltrexone and behavioral therapy offered no benefit over behavioral therapy alone. However, gabapentin did provide some short-term benefits. It remains to be seen whether prescribing it for longer periods would be effective.
Darius A. Rastegar, MD
Anton RF, Myrick H, Wright TM, et al. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011;168(7):709–717.