Treatment of alcohol withdrawal syndrome with carbamazepine, gabapentin, and nitrous oxide.
OBJECTIVE
To evaluate the potential use of carbamazepine, gabapentin, and nitrous oxide as alternatives to symptom-triggered benzodiazepine administration for the treatment of alcohol withdrawal syndrome (AWS), a literature review was conducted.


CONCLUSIONS
English-language reports of clinical trials of these agents in AWS, particularly trials that compared them with benzodiazepines or anticonvulsants or used them as benzodiazepine-sparing therapy, were reviewed. Six randomized, double-blind trials compared carbamazepine with agents used in the United States. The results suggest that carbamazepine may be useful for this indication, particularly in outpatient settings, although adverse effects and drug interactions may limit its usefulness. The role of gabapentin is unclear because of the lack of randomized, double-blind, controlled trials and the conflicting results of existing case series and open-label trials. Two poorly designed trials of nitrous oxide had conflicting results.


CONCLUSIONS
Because of the limitations in evidence accrued so far, the routine use of carbamazepine and gabapentin for the treatment of AWS cannot be recommended, and nitrous oxide should be avoided for this indication.
Prince
Valerie
V
McWhorter School of Pharmacy, Samford University, Birmingham, AL 35229, USA.
Turpin
Kelly R
KR
D000588:Amines / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use*; D002220:Carbamazepine / Q000627:therapeutic use*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D000431:Ethanol / Q000009:adverse effects*; D000077206:Gabapentin; D006801:Humans; D009609:Nitrous Oxide / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000209:etiology; D014481:United States; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use*
D000588:Amines; D018712:Analgesics, Non-Narcotic; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D002220:Carbamazepine; D000431:Ethanol; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009609:Nitrous Oxide