Self-reported sleep, sleepiness, and repeated alcohol withdrawals: a randomized, double blind, controlled comparison of lorazepam vs gabapentin.
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.
Malcolm
Robert
R
Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, USA. malcolmr@musc.edu
Myrick
L Hugh
LH
Veatch
Lynn M
LM
Boyle
Elizabeth
E
Randall
Patrick K
PK
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*
D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018757:GABA Modulators; D000431:Ethanol; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D008140:Lorazepam