Impact of Gabapentin Adjunct use with Benzodiazepines for the Treatment of Alcohol Withdrawal in a Psychiatric Hospital.

Introduction: Benzodiazepines are currently the gold standard for treatment of alcohol withdrawal. Gabapentin has growing evidence to support its use in the treatment of alcohol use disorder, however there is limited evidence regarding its role in the treatment of alcohol withdrawal. The purpose of this study was to determine if adjunctive gabapentin reduces the need for benzodiazepine (BZD) administration during alcohol withdrawal.

Methods: This was a retrospective single-center cohort study. Patients were included if they were 18-89 years old, had an underlying alcohol use disorder, and were initiated on the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) protocol with or without scheduled gabapentin. They were excluded if they had a BZD use disorder, were on concomitant anti-epileptics, as-needed gabapentin, or BZDs outside the CIWA-Ar protocol.

Results: A total of 129 patients met inclusion criteria (n = 63 gabapentin group and 66 non-gabapentin group). There was a significant difference in as-needed BZD requirements, with the gabapentin group requiring a higher number of as-needed BZDs in the initial 72 hours of treatment (gabapentin 6 [IQR 0.5-10] non-gabapentin 2 [IQR 0-4]; p = 0.01) and overall (gabapentin 6 [IQR 0.5-10] vs. non-gabapentin 2 [IQR 0-5.5]; p = 0.01). The gabapentin group also had higher maximum CIWA-Ar scores in the initial 72 hours of treatment, and higher anxiety item scores in the initial 48 hours.

Conclusion: Gabapentin was not shown to reduce as-needed BZD requirements in patients with a diagnosis of alcohol use disorder admitted for alcohol withdrawal.