title: Self-reported sleep, sleepiness, and repeated alcohol withdrawals: a randomized, double blind, controlled comparison of lorazepam vs gabapentin.
abstract: OBJECTIVE
  Insomnia is a central symptom of alcohol withdrawal and increases relapse potential. The primary objective of this study was to compare the efficacy of gabapentin to lorazepam in alleviating sleep disturbances and daytime sleepiness during an episode of alcohol withdrawal. The secondary objective of this study was to determine if drug treatment efficacy differed by the patient history of previous treatments for alcohol withdrawal.
  
  
  METHODS
  Outpatients in treatment for alcohol withdrawal received a 4-day fixed-dose taper of gabapentin or lorazepam in a double-blind, randomized, controlled trial with an 8-day follow-up. Daily across a 5 day outpatient treatment and Days 7 and 12 post-treatment, patients self-reported daytime sleepiness using the Epworth Sleepiness Scale. Self-reports of depression (Beck Depression Inventory) were completed at Days 1, 5, 7 and 12. Staff assessed daily alcohol withdrawal using the Clinical Institute Withdrawal Assessment for Alcohol. From these instruments, self-reported sleep and sleepiness were extracted and assessed in the context of limited (0-1) or multiple (2 or more) previously treated alcohol withdrawal episodes.
  
  
  RESULTS
  Patients with limited previous withdrawals reported similar treatment effects on self-reports of sleep and sleepiness for gabapentin and lorazepam. In contrast, patients with multiple previous alcohol withdrawals receiving gabapentin reported reduced sleep disturbances and sleepiness in comparison to those receiving lorazepam.
  
  
  CONCLUSIONS
  During treatment for alcohol withdrawal, gabapentin as compared to standard therapy with lorazepam, was superior on multiple sleep measures, in patients who had previous withdrawals. Lorazepam subjects experienced rebound symptoms. Early drinking was related to persisting insomnia with both drugs.
authors.affiliation: Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, USA. malcolmr@musc.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Malcolm
authors.forename: L Hugh
authors.initials: LH
authors.lastname: Myrick
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Veatch
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Boyle
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Randall
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000517:prevention & control*; D000588:Amines / Q000627:therapeutic use*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology*; D004311:Double-Blind Method; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D018757:GABA Modulators / Q000627:therapeutic use*; D000077206:Gabapentin; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D011795:Surveys and Questionnaires; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use*
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018757:GABA Modulators; D000431:Ethanol; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D008140:Lorazepam