Gabapentin versus chlordiazepoxide for outpatient alcohol detoxification
treatment.
Author(s): Stock CJ(1), Carpenter L, Ying J, Greene T.
Affiliation(s): Author information:
(1)Mental Health Care Center (116), Veterans Affairs Salt Lake City Health Care
System, Salt Lake City, UT, USA. Christopher.Stock@va.gov
Publication date & source: 2013, Ann Pharmacother. , 47(7-8):961-9
BACKGROUND: Benzodiazepines are used to treat alcohol withdrawal (AW) but cause
cognitive impairment, sedation, and ataxia, and interact with alcohol.
Nonbenzodiazepine anticonvulsants are promising and possibly safer alternatives
for the treatment of AW.
OBJECTIVE: To compare follow-up measures of Epworth Sleepiness Scale (ESS), Penn
Alcohol Craving Scale (PACS), ataxia rating, and Clinical Institute Withdrawal
Assessment for Alcohol revised (CIWA-Ar) symptoms between alcohol-dependent
individuals randomized to treatment with gabapentin or chlordiazepoxide.
METHODS: A randomized, double-blind study was conducted in US veterans with
alcohol withdrawal (DSM-IV criteria). Subjects requiring hospitalization or
taking benzodiazepines or nonbenzodiazepine anticonvulsants were excluded.
Twenty-six participants were randomized: 17 received gabapentin and 9 received
chlordiazepoxide. Gabapentin doses were 1200 mg orally for 3 days, followed by
900 mg, 600 mg, and 300 mg for 1 day each. Chlordiazepoxide doses were 100 mg
orally for 3 days, followed by 75 mg, 50 mg, and 25 mg for 1 day each. CIWA-Ar,
ESS, PACS scales and evaluation for ataxia were administered daily.
RESULTS: Follow-up mean ESS and PACS scores did not differ significantly between
treatment groups in the early treatment period (days 1-4) but were lower (mean
difference -3.70; 95% CI -7.21 to -0.19; p = 0.04) and (mean difference -6.05;
95% CI -12.82 to 0.72; p = 0.08), respectively, at the end of the treatment
period (days 5-7) in gabapentin-treated subjects. CIWA-Ar scores were reduced
similarly in both groups. Ataxia was not observed. No significant adverse events
were noted. Limitations include our small sample size and 35% loss to follow-up
at the end of the treatment period.
CONCLUSIONS: In ambulatory veterans with symptoms of alcohol withdrawal,
gabapentin treatment resulted in significantly greater reduction in sedation
(ESS) and a trend to reduced alcohol craving (PACS) by the end of treatment
compared to chlordiazepoxide treatment. Although limited by the small sample
size, the suggestion of reduction in sleepiness and less craving warrants
replication of the study with a larger sample.
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