Gabapentin reduced drinking, cravings, sleep and mood problems in alcoholics

Treatment with gabapentin reduced alcohol consumption and relapse-related symptoms in patients with alcohol dependence, a recent single-center study found.

The 12-week, double-blind trial ran from 2004 to 2010 at 1 outpatient research facility and randomized 150 men and women with alcohol dependence to placebo, 900 mg of gabapentin daily or 1,800 mg of gabapentin daily, along with counseling. Outcomes were rates of complete abstinence and no heavy drinking and changes in mood, sleep and craving. Results were published by JAMA Internal Medicine on Nov. 4.

Gabapentin, especially the higher dose, significantly increased abstinence over the 12 weeks. Rates were 4.1% on placebo (95% CI, 1.1% to 13.7%), 11.1% on the lower dose (95% CI, 5.2% to 22.2%) and 17.0% in the higher-dose group (95% CI, 8.9% to 30.1%) (P=0.04 for linear dose effect). A similar pattern was seen in the percentage of patients who refrained from heavy drinking (22.5% on placebo, 29.6% on 900-mg gabapentin, and 44.7% on 1,800 mg; P=0.02 for linear dose effect). Mood, sleep and cravings also showed similar effects. The study had no serious drug-related adverse events, and discontinuation rates were similar across groups.

The results indicate that gabapentin (particularly the 1,800-mg dose) was effective with a favorable safety profile and could facilitate increased pharmacological treatment of alcohol dependence in primary care, the study authors concluded. They acknowledged that the study was limited by a high dropout rate (although one equivalent to similar studies), its use of a single center, and inclusion only of patients who could refrain from drinking for 3 days before starting gabapentin. Future studies should test this treatment in larger, more diverse populations, the authors said.

An accompanying editorial noted that the use of anticonvulsants (specifically, topiramate) for alcohol dependence has been previously studied but that the adverse effect profile of gabapentin appears superior based on this study. A variety and possibly a combination of approaches may be the solution to treating this condition, the editorial said. In general, medications are underutilized in treatment for alcohol dependence, the editorialist wrote, urging primary care physicians to embrace “the mandate to recognize and treat alcoholism and other addictions.”