Gabapentin also known to many as Neurontin is an anticonvulsant and analgesic drug. This drug was originally developed to treat epilepsy however it also works well in relieving is neuropathic pain and is now used for pain relief in most hospitals worldwide. It is recommended as a first line agent for the treatment of neuropathic pain arising from diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain. This drug may also be prescribed for other off-label uses such as treatment of restless leg syndrome, anxiety disorders, insomnia, and bipolar disorder. There are, however, concerns regarding the quality of the trials conducted and evidence for some such uses, especially in the case of its use as a mood stabilizer in bipolar disorder. More research needs to be conducted to ascertain the use of this drug as a mood stabilizer in bipolar disorder.
Benzodiazepines are used to treat alcohol withdrawal (AW) but they are known to cause cognitive impairment, sedation, and ataxia, and interact with alcohol. Nonbenzodiazepine anticonvulsants are promising and possibly safer alternatives for the treatment of Alcohol Withdrawal.
There several studies that have been conducted on this area especially comparing gabapentin and Chlordiazepoxide. In one of these studies the objective was to find out which of these two medications was safe and effective rather the objective was to compare the safety and effectiveness of these two medications. In this study the patients were divided into two groups. The first group was given gabapentin while the other group was given chlordiazepoxide. The subjects were then monitored after 7 days alcohol abstinence, withdrawal severity scores, adverse events including ataxia, sedation, cognitive function and alcohol craving. The results of this study however were never published. To others it may seem useless speaking about a study whose findings was not even published but the very existent of the research speaks volumes. For a fact it shows that chlordiazepoxide that had been used in the past in dealing with patients of alcohol withdrawal had some inefficiencies or had some serious side effects that needed to be corrected therefore a better medication was indeed needed to replace it. However, this is the authors own opinion lets proceed to other research studies that had been done on this subject.
There is also another study whose objective was to compare follow-up measures of Epworth Sleepiness Scale (ESS), Penn Alcohol Craving Scale (PACS), ataxia rating, and Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) symptoms between alcohol-dependent individuals randomized to treatment with gabapentin or chlordiazepoxide. In this study it was found that in ambulatory veterans with symptoms of alcohol withdrawal, gabapentin treatment resulted in significantly greater reduction in sedation (ESS) and a trend to reduced alcohol craving (PACS) by the end of treatment compared to chlordiazepoxide treatment. Although limited by the small sample size, the suggestion of reduction in sleepiness and less craving warrants replication of the study with a larger sample.
In the fight to overcome alcohol dependence various strategies are used. In some cases a single drug maybe used successfully in fighting alcohol while in other cases two or more drugs may be combined for the same course to help fighting alcohol dependence more effectively. Gabapentin can be used singly to fight alcohol dependence but it can also be combined with naltrexone for more effective action against alcohol dependence.
There are some research studies that have been done on this subject and findings published. In a July 11, 2011 Raymond F. Anton, MD, professor of psychiatry at the Medical University of South Carolina, and colleagues reported their findings in the July issue of the American Journal of Psychiatry.
The report indicated that the addition of gabapentin to naltrexone improved drinking outcomes compared with naltrexone alone in heavy drinkers during the first 6 weeks after they stopped drinking, but when the gabapentin was stopped the effects became the same in both groups, so this shows that gabapentin was indeed responsible for the positive effects.
“From work in mice and rats we know that the underlying biology of alcohol dependence, particularly alcohol withdrawal, is mediated by two neurotransmitters — GABA [gamma-aminobutyric acid] and glutamate. Alcohol use causes these neurotransmitters to be abnormal and, particularly during alcohol withdrawal, to cause significant symptoms,” Dr. Anton told Medscape Medical News.
“We knew that the drug gabapentin works through these systems to normalize the balance of the glutamate and GABA systems in the opposite direction to what alcohol does, and we had done previous studies with gabapentin in mice and in humans showing that it reduced the symptoms of alcohol withdrawal. That led to our hypothesis that using gabapentin, particularly during the first 6 weeks of attempts at abstinence, might improve the efficacy of naltrexone,” he explained.
This study used randomly selected 150 alcohol dependent individuals who were put on a 16-week course of naltrexone, 50 mg/d alone; naltrexone, 50 mg/d, plus gabapentin up to 1200 mg/d for the first 6 weeks; or to double placebo. They also received medical management. Most of these participants were in their mid-forties. They were dependent on alcohol and drank 12-13 alcoholic drinks per day before the study entry. By week 6, about 50% of the individuals randomly assigned to placebo or naltrexone alone had a heavy drinking day, compared with about 35% of individuals who got naltrexone plus gabapentin. But by week 16 of the study, there were no differences between the groups. This show that gabapentin works better when combined with naltrexone than when naltrexone is used alone.
Dependence on alcohol and drugs is vice that has crippled societies and that is why here at AWAREmed we are dedicated to finding the best solutions to addiction and dependence on substances. Dr. Dalal Akoury (MD) is always in the mood of helping any patient to be addiction free. Do not hesitate to call on her for help in managing any sort of chronic pain as well as other diseases.