Anticonvulsant May Aid in Alcohol Dependence

Gabapentin, a common anticonvulsant medication, may be safe and effective in the treatment of alcohol dependence and relapse-related symptoms, according to the results of a recent US study.

Researchers led by Barbara J. Mason, PhD, The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA, found that individuals assigned to gabapentin experienced higher abstinence rates and higher rates of no heavy drinking, had lower alcohol intake, and reported fewer relapse-related symptoms (cravings, sleeplessness, and depression) than those taking placebo.
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Despite the fact that there are US Food and Drug Administration (FDA)–approved medications for the prevention of relapse in individuals with alcohol dependence, “medications for alcohol dependence are sorely underutilized,” writes Edward V. Nunes, MD, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, in an accompanying editorial.

Mason and colleagues conducted a double-blind, placebo-controlled, dose-ranging trial involving 150 patients (age >18 years; mean age, 44 years) with current alcohol dependence. They examined whether gabapentin increases the rates of sustained abstinence and no heavy drinking and decreases the alcohol-related symptoms of insomnia, dysphoria, and craving in a dose-dependent manner.

The study, which was funded by the National Institute on Alcohol Abuse and Alcoholism (part of the National Institutes of Health), randomized participants into three treatment groups: oral gabapentin 900 mg/day or 1800 mg/day, or placebo. Patients were also provided with concomitant weekly manual-guided counseling. Researchers observed the rates of complete abstinence and no heavy drinking, as well as alterations in their sleep, mood, and craving, over a 12-week period.

Patients in the 1800-mg and 900-mg gabapentin groups experienced abstinence rates of 17% and 11.1%, respectively, as compared with the 4.1% abstinence rate in the placebo group. In addition, Mason and colleagues found that approximately 45% and 30% of patients taking gabapentin 1800 mg and 900 mg, respectively, did not engage in heavy drinking, as compared with 22.5% in the placebo group. Gabapentin also significantly reduced the secondary outcomes of depression, sleeplessness, and cravings compared with placebo.

There were no serious drug-related side effects reported by the participants of the study.

This research was published in the November issue of JAMA Internal Medicine.

-Meredith Edwards White

References
Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA Intern Med. 2013 Nov 4. doi: 10.1001/jamainternmed.2013.11950. [Epub ahead of print]

Nunes EV. Gabapentin: a new addition to the armamentarium for alcohol dependence? JAMA Intern Med. 2013 Nov 4. doi: 10.1001/jamainternmed.2013.11973. [Epub ahead of print]