An open trial of gabapentin in acute alcohol withdrawal using an oral loading protocol.
OBJECTIVE
Anticonvulsants are increasingly being advocated for the treatment of acute alcohol withdrawal syndrome (AWS) to avoid the addictive properties of established medications. Because earlier works showed that moderate gabapentin doses were too low to clearly ameliorate severe AWS, we tested a higher gabapentin entry dose.


METHODS
Inpatients (n = 37) with severe alcohol withdrawal symptoms (Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-AR) score > or =15 points) were given gabapentin 800 mg, and if their symptom score reduced within 2 h, they were termed 'early responders' and were then treated for 2 days with 600 mg gabapentin q.i.d. (i.e. a total of 3200 mg in the first 24 h) before beginning a taper.


RESULTS
Twenty-seven (73%) were early responders (baseline CIWA-AR improved from 17.3 +/- 2.6 to 8.0 +/- 3.6 points). In the remaining 10 patients, baseline CIWA-AR deteriorated within 2 h (from 20.1 +/- 4.6 to 21.5 +/- 4.65 points). These patients were switched to clomethiazole (n = 4) or clonazepam (n = 6), which is the usual treatment. Three of the 'early responders' worsened in the next 36 h and were then reclassified and treated as 'non-responders'. Among them, two developed an epileptic seizure.


CONCLUSIONS
Oral 800 mg gabapentin (loaded up to 3200 mg in the first 24 h) is helpful only in reducing less severe and less complicated acute AWS.
Bonnet
Udo
U
LVR-Hospital of Essen, University of Duisburg-Essen, Virchowstr. 174, D-45147 Essen, Germany. udo.bonnet@lvr.de
Hamzavi-Abedi
Reza
R
Specka
Michael
M
Wiltfang
Jens
J
Lieb
Bodo
B
Scherbaum
Norbert
N
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D020270:Alcohol Withdrawal Seizures / Q000097:blood / Q000534:rehabilitation*; D000437:Alcoholism / Q000097:blood / Q000534:rehabilitation*; D000588:Amines / Q000008:administration & dosage* / Q000009:adverse effects; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002719:Chlormethiazole / Q000008:administration & dosage / Q000009:adverse effects; D002998:Clonazepam / Q000008:administration & dosage / Q000009:adverse effects; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000431:Ethanol / Q000097:blood; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage* / Q000009:adverse effects
D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D002719:Chlormethiazole; D000431:Ethanol; D005680:gamma-Aminobutyric Acid; D002998:Clonazepam; D000077206:Gabapentin