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Cited by 186Substance Abuse Treatment and OutcomesAlcoholism and Thiamine DeficiencyAlcohol Consumption and Health Effects

Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial

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Anton, Raymond F., Latham, Patricia, Voronin, Konstantin, Book, Sarah, Hoffman, Michaela, Prisciandaro, James, Bristol, Emily·2020·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2020.0249PMC PMC7063541
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Abstract

Importance: Although an estimated 30 million people meet criteria for alcohol use disorder (AUD), few receive appropriate pharmacotherapy. A more personalized, symptom-specific, approach might improve efficacy and acceptance. Objective: To examine whether gabapentin would be useful in the treatment of AUD, especially in those with the most alcohol withdrawal symptoms. Design, Setting, and Participants: This double-blind randomized clinical trial conducted between November 2014 and June 2018 evaluated gabapentin vs placebo in community-recruited participants screened and treated in an academic outpatient setting over a 16-week treatment period. A total of 145 treatment-seeking individuals who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for AUD and were not receiving other AUD intervention were screened, and 96 who also met recent alcohol withdrawal criteria were randomized to treatment after 3 abstinent days. Daily drinking was recorded, and percentage of disialo carbohydrate-deficient transferrin in the blood, a heavy drinking marker, was collected at baseline and monthly during treatment. Interventions: Gabapentin up to 1200 mg/d, orally, vs placebo along with 9 medical management visits (20 minutes each). Main Outcomes and Measures: The percentage of individuals with no heavy drinking days and those with total abstinence were compared between treatment groups and further evaluated based on prestudy alcohol withdrawal symptoms. Results: Of 96 randomized individuals, 90 were evaluable (44 in the gabapentin arm and 46 in the placebo arm), with a mean (SD) age of 49.6 (10.1) years; 69 were men (77%) and 85 were white (94%). The evaluable participants had 83% baseline heavy drinking days (4 or more drinks/day for women, 5 or more for men) and met 4.5 alcohol withdrawal criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). More gabapentin-treated individuals had no heavy drinking days (12 of 44 participants [27%]) compared with placebo (4 of 46 participants [9%]), a difference of 18.6% (95% CI, 3.1-34.1; P = .02; number needed to treat [NNT], 5.4), and more total abstinence (8 of 44 [18%]) compared with placebo (2 of 46 [4%]), a difference of 13.8% (95% CI, 1.0-26.7; P = .04; NNT, 6.2). The prestudy high-alcohol withdrawal group had positive gabapentin effects on no heavy drinking days (P < .02; NNT, 3.1) and total abstinence (P = .003; NNT, 2.7) compared with placebo, while within the low-alcohol withdrawal group, there were no significant differences. These findings were similar for other drinking variables, where gabapentin was more efficacious than placebo in the high-alcohol withdrawal group only. Gabapentin caused more dizziness, but this did not affect efficacy. Conclusions and Relevance: These data, combined with others, suggest gabapentin might be most efficacious in people with AUD and a history of alcohol withdrawal symptoms. Future studies should evaluate sleep changes and mood during early recovery as mediators of gabapentin efficacy. Trial Registration: ClinicalTrials.gov Identifier: NCT02349477.

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  • In an RCT of 90 individuals with AUD and recent alcohol withdrawal symptoms, gabapentin (up to 1200 mg/d) produced more non-heavy drinking days than placebo (27.0% vs 9.0%).

    “In an RCT comparing gabapentin to a placebo in 90 individuals with AUD and recent alcohol withdrawal symptoms, participants received gabapentin (up to 1200 mg/d) or a placebo along with medical management visits over a 16-week period. The gabapentin group achieved more non-heavy drinking days (27.0% vs. 9.0%)”

    From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [66]

    The Abstract (page not provided) reports 96 randomized participants, 90 evaluable participants, gabapentin up to 1200 mg/d, and a 16-week treatment period with medical management visits. It reports that 27% of gabapentin participants versus 9% of placebo participants had no heavy drinking days—not that 27% versus 9% of days were non-heavy drinking days. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Gabapentin caused more dizziness than placebo but this did not impact its efficacy.

    “Although gabapentin caused more dizziness, it did not impact its efficacy.”

    From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [66]

  • In the same RCT, gabapentin's effects were more pronounced in participants with a history of high alcohol withdrawal symptoms.

    “These effects were more pronounced in participants with a history of high alcohol withdrawal symptoms.”

    From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [66]

  • In the same RCT, gabapentin produced more total abstinence than placebo (18.0% vs 4.0%).

    “and total abstinence (18.0% vs. 4.0%) compared to the placebo group.”

    From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [66]

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8 of the 74 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [43]43. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition. Version. 2.0. New York, NY: New York State Psychiatric Institute; 1997.

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Authors
Anton, R. F., Latham, P., Voronin, K., Book, S., Hoffman, M., Prisciandaro, J., & Bristol, E.
Affiliations
Medical University of South Carolina (US)
Corresponding author
Anton, Raymond F.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2020-05-01
Volume
180
Issue
5
Pages
728
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2020.0249
PMC
PMC7063541
OpenAlex
W3010028573
Cited by
186
References
74
Citations by year
2026: 19 · 2025: 23 · 2024: 39 · 2023: 29 · 2022: 33 · 2021: 30 · 2020: 12
FWCI
18.65
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute on Alcohol Abuse and Alcoholism (R01AA025365, R01AA022364, K23AA020842, P50AA010761)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords
gabapentin, alcoholism, alcohol withdrawal symptoms, pharmacotherapy, heavy drinking, abstinence, outpatient care, alcoholism treatment, relapse prevention, alcohol and cancer risk, alcoholic liver disease
MeSH terms
Gabapentin, Adult, Alcoholism, Double-Blind Method, Female, Humans, Male, Middle Aged, Substance Withdrawal Syndrome, Treatment Outcome, Excitatory Amino Acid Antagonists, Alcohol Abstinence

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