Tools for Practice Outils pour la pratique


#278 Gabapentin for Alcohol Use Disorder: Decrease pints with a pill?


CLINICAL QUESTION
QUESTION CLINIQUE
Is gabapentin effective in treating alcohol use disorder (AUD)?


BOTTOM LINE
RÉSULTAT FINAL
More patients on gabapentin (27%) could avoid heavy drinking days (example >5 standard drinks/day) compared to those on placebo (9%). There is mixed evidence for gabapentin and abstinence. Gabapentin may be considered as a second-line option (off-label) for AUD (after acamprosate or naltrexone). Concerns regarding abuse/misuse and drug related harms should inform therapeutic discussion. 



CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session



EVIDENCE
DONNÉES PROBANTES
Results statistically significant unless noted. 
  • Systematic review, 7 randomized controlled trials (RCTs), 3-26 weeks, 730 participants, with alcohol dependence or AUD, 300-3600mg gabapentin/day (immediate or delayed release) versus placebo, most included regular follow-up visits after ~3 days abstinence. Gabapentin:1 
    • Decreased percentage of heavy drinking days. 
      • Absolute numbers not reported. 
    • No difference total abstinence. 
    • 10% higher rate adverse events, no serious events reported. 
  • Recent RCT (not in above review) gabapentin versus placebo: 
    • 90 patients mean age 50, 77% male, average 11 drinks/day. Objective urine test used to confirm drinking/abstinence. 1200mg of gabapentin/day for 16 weeks increased:2 
      • No heavy drinking days (>5 standard drinks/day): 
        • 27% versus 9% (placebo), number needed to treat (NNT)=6. 
      • Total abstinence: 
        • 18% versus 4% (placebo), NNT=8. 
      • Patients with more withdrawal symptoms benefit more. 
    • Adverse events: dizziness, 56% versus 33% (placebo), number needed to harm=4. 
Context: 
  • Gabapentin is recommended (off-label) as second line for moderate to severe AUD.3 
    • Recommended first line agents include acamprosate and naltrexone with NNTs of 12 and 20, respectively, for abstinence.3,4 
  • Gabapentin misuse in general population is ~1%, and up to 15-22% in patients with history of opioid abuse. Risk with alcohol abuse history less clear.5 
  • Gabapentin related cases reported to US poison control increased by 72% between 2013-2017, including 120% increase in abuse/misuse and 80% increase in suicidality.6 
  • One observational study reported the death rate of those prescribed gabapentin for any reason was double that of the general population (RR 2.16), patients receiving these prescriptions may be at higher baseline risk.7 Excess alcohol also increases mortality.8 
  • Clinicians should be aware of potential misuse/diversion when prescribing gabapentin.9 


Elaine Riddick June 9, 2021

I think that gabapentin increases the effect of alcohol in the same way that phenytoin does. If you take gabapentin and feel drunk at 3 drinks then no need to drink more

Gilbert Bretecher May 10, 2023

Gabapentin reasonably effective in AUD


Latest Tools for Practice
Derniers outils pour la pratique

#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

What are the risks and benefits of ubrogepant for the acute treatment of episodic migraines?
Read Lire 0.25 credits available Crédits disponibles

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?
Read Lire 0.25 credits available Crédits disponibles

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session


Author(s)
Auteur(s)
  • Justin Weresch MD CCFP
  • Jessica Kirkwood MD CCFP (AM)
  • Christina Korownyk MD CCFP

1. Kranzler HR, Feinn R, Morris P, et al. Addiction. 2019; 114(9):1547-1555

2. Anton RF, Latham P, Voronin K, et al. JAMA Intern Med. 2020; 180(5):1-9

3. British Columbia Centre on Substance Use (BCCSU), B.C. Ministry of Health and B.C. Ministry of Mental Health and Addictions. Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder. 2019. Vancouver, B.C.: BCCSU. Available at: https://www.bccsu.ca/clinical-care-guidance/. Accessed June 1, 2020.

4. Finley CR, Rumley C, Korownyk CS. Can Fam Physician. 2020; 66(8):583.

5. Smith RV, Havens JR, Walsh SL. Addiction. 2016; 111(7):1160-1174.

6. Reynolds K, Kaufman R, Korenoski A, et al. Clin Toxicol (Phila). 2020; 58(7):763-772.

7. Torrance N, Veluchamy A, Zhou Y, et al. Br J Anaesth. 2020; 125(2):159-167.

8. Di Castelnuovo A, Costanzo S, Bagnardi V, et al. Arch Intern Med. 2006; 166:2437-45.

9. Lennox R, Mangin D. CMAJ. 2019; 191(2):E47.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.