Anticonvulsants for alcohol withdrawal: A review of the evidence
Several agents may be useful for treating mild to moderate withdrawal symptoms.
A few caveats
Our review focused a large collection of data from multiple databases and RCTs only. However, its limitations include:
- there was no measure of heterogeneity
- the studies had short treatment duration
- most studies evaluated predominantly male participants
- some studies were underpowered.
Our review laid a groundwork for future research that includes more well-designed RCTs and/or meta-analyses of recent studies that evaluated the use anticonvulsants for treating AWS.
Bottom Line
Evidence suggests certain anticonvulsants may be an effective alternative to benzodiazepines for the treatment of mild to moderate alcohol withdrawal syndrome. Gabapentin may be the safest anticonvulsant to prescribe. Other anticonvulsants to consider include carbamazepine, sodium valproate, and lamotrigine, but for these agents, the risks might outweigh the benefits.
Related Resources
- Myrick H, Anton RF. Treatment of alcohol withdrawal. Alcohol Health Res World. 1998;22(1):38-43. https://pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf
- World Health Organization. Management of alcohol withdrawal. Published 2012. https://www.who.int/mental_health/mhgap/evidence/alcohol/q2/en/
Drug Brand Names
Carbamazepine • Tegretol
Gabapentin • Neurontin
Lamotrigine • Lamictal
Levetiracetam • Keppra
Lorazepam • Ativan
Oxcarbazepine • Trileptal
Phenytoin • Dilantin
Sodium valproate • Depakote
Acknowledgments
The authors thank Geetha Manikkara, MD, Madhuri Jakkam Setty, MD, and Elizabeth DeOreo, MD, for their efforts with the systematic review research.
