Alcohol withdrawal: When to choose an adjunctive anticonvulsant
Anticonvulsants may reduce detoxification symptoms, support recovery.
Mr. B requires a total of 2 mg of lorazepam throughout hospitalization. He finishes alcohol detoxification on day 4 and is discharged with a prescription for gabapentin, 1,200 mg tid. Two weeks later, when he is admitted to a 28-day inpatient alcohol rehabilitation unit, Mr. B has not relapsed.
More abstinent days
Gabapentin is FDA-approved as adjunctive therapy for partial seizures. Off-label, it has been generally efficacious as an adjunct in alcohol detoxification.29-32 We chose adjunctive anticonvulsant therapy for Mr. B because of his history of alcohol-induced seizures. We chose gabapentin instead of valproic acid because of Mr. B’s liver damage and gabapentin’s lack of hepatic metabolism.
Gabapentin may reduce alcohol consumption and craving in alcohol-dependent patients. By increasing the number of abstinent days, gabapentin may help patients maintain abstinence.33 Gabapentin does not appear to interact clinically with alcohol, causing neither sedation nor synergistic effects.34 Its relative lack of abuse potential may be valuable in outpatient alcohol withdrawal treatment and in maintaining alcohol abstinence after detoxification.
Related resource
- Asplund CA, Aaronson JW, Aaronson HE. 3 regimens for alcohol withdrawal and detoxification. J Fam Pract. 2004;53(7):545-554. www.jfponline.com/Pages.asp?AID=1730.
Drug brand names
- Acamprosate • Campral
- Alprazolam • Xanax
- Carbamazepine • Carbatrol
- Cimetidine • Tagamet
- Clonazepam • Klonopin
- Clonidine • Catapres
- Diazepam • Valium
- Disulfiram • Antabuse
- Felbamate • Felbatol
- Fluoxetine • Prozac
- Gabapentin • Neurontin
- Isoniazid • Nydrazid
- Lamotrigine • Lamictal
- Levetiracetam • Keppra
- Lorazepam • Ativan
- Naltrexone • ReVia, Vivitrol
- Oxazepam • Serax
- Phenobarbital • Luminal
- Phenytoin • Dilantin
- Propranolol • Inderal
- Rifampin • Rifadin
- Ritonavir • Norvir
- Temazepam • Restoril
- Triazolam • Halcion
- Valproic acid • Depakote, Depakene
Disclosures
Dr. Spiegel is a speaker for Pfizer Inc. and GlaxoSmithKline.
Dr. Radac reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Acknowledgment
The authors thank Rishi Laroia, MD, Robert Swanson, MD, and Adam W. Coe, MD for their contributions to this article.
