Gabapentin for Use on Patients with Alcohol Withdrawal Syndrome: An Integrative Review of the Literature

Problem: Up to 2 million Americans suffer from alcohol withdrawal syndrome (AWS) each year. Alcoholism contributes to a significant number of co-morbidities and mortality (Enoch & Goldman, 2002). Some of the most commonly prescribed medications for alcohol withdrawal and dependence have disappointing efficacy and undesirable side effects. The neurotransmitter γ-amino-butyric acid (GABA) disregulation has been the focus of research into the pathophysiology of AWS (Cagetti, Liang, & Spigelman (2003); Olsen, Liang, & Cagetti, 2005). Alcohol increases the effect of GABA. Long term exposure to alcohol causes down-regulation of GABA neuroreceptors (Olsen, Liang, & Cagetti, 2005; Bayard, Mcintyre, Hill & Woodside, 2004). Roberto, et al. (2008) found that gabapentin infused directly into the nucleus of the amygdala reduced ethanol dependence and reversed "behavioral measures of ethanol dependence" in mice. Clemens & Vendruscolo (2008) found the anxiety producing effects of ethanol withdrawal were reversed with application of gabapentin directly to the amygdala of ethanol dependent mice. These studies suggest that more research needs to focus on the role of gabapentin in treating AWS and preventing relapse in alcohol dependent individuals. The purpose of this integrative review was to analyze the peer reviewed body of research on the use of the anticonvulsant gabapentin on patients with AWS. Methods/procedure/approach: Search terms used were combinations of gabapentin, Alcohol Withdrawal, and Ethanol Withdrawal. Two electronic databases were searched: CINAHL Ebsco Host and PubMed and an ancestry search was performed. Inclusion criteria were English language studies between 2006 and 2012. The search yielded 47 results. Articles were excluded that described treating other substance addictions or for treatment of seizures. The resulting search was narrowed to 13 studies from 4 countries using a total of 319 study participants. Results/findings/product: Twelve of the 13 studies reviewed revealed gabapentin may be equal to or superior than other treatment regimens currently in use. Gabapentin was shown to be safe, even for patients who drink while taking the medication. Gabapentin was not effective in patients having the most severe or the mildest symptoms. Conclusion/implications: Additional clinical investigations are indicated to demonstrate whether gabapentin should become more widely used as an adjunct or preferred treatment for alcohol dependence and AWS. The existing body of knowledge is supportive but limited