Gabapentin Can Decrease Heavy Drinking and Increase Abstinence for Patients with Alcohol Dependence

Existing pharmacotherapies for alcohol use disorders have modest efficacy and there are few choices. Researchers tested gabapentin, 900 mg and 1800 mg three times a day, versus placebo, in a randomized trial. The 150 adults had alcohol dependence, were abstinent for at least 3 days, did not use other drugs or have significant comorbidity, and were recruited by advertisements. Primary outcomes were ascertained for 97% of participants.

• At 12 weeks, there was a linear dose effect, and abstinence (17% versus 4%) and no heavy drinking (45% versus 23%) were more common in the 1800 mg dose group, although 95% confidence intervals for these effects overlapped with the lower dose and with effects in the placebo group.
• Findings beyond consumption (such as sleep outcomes) were difficult to interpret because of substantial loss to follow-up.

Comments:

This trial appears to provide proof of the concept that gabapentin can reduce consumption among people with alcohol dependence (corresponding in DSM-5 to moderate to severe alcohol use disorder). Although many clinicians may be eager to have another treatment option, careful subject selection (not in a general medical setting), the abuse potential of gabapentin, and the overlapping confidence intervals across the study groups suggest that widespread use of the treatment for dependence should await a larger effectiveness trial.

Richard Saitz MD, MPH

Reference:

Mason BJ, Quello S, Goodell V, et al. Gabapentin Treatment for Alcohol Dependence: A Randomized Clinical Trial. JAMA Intern Med. 2014;174(1):70–77.