Use of Gabapentin for Alcohol Withdrawal Syndrome in the Hospital Setting: A Randomized Open-Label Controlled Trial

Area of Science:

• Internal Medicine
• Pharmacology

Background:

• Hospitalized patients with alcohol withdrawal syndrome (AWS) often receive benzodiazepines.
• Gabapentin is an effective outpatient AWS treatment, but its inpatient efficacy is less studied.
• Limited data exists on gabapentin as an alternative to benzodiazepines for hospitalized AWS patients.

Purpose of the Study:

• To compare fixed-dose gabapentin with CIWA-directed benzodiazepines for hospitalized AWS treatment.
• To evaluate the efficacy and safety of gabapentin in an inpatient setting for AWS.

Main Methods:

• An open-label, randomized controlled trial involving 88 adult patients at risk for complicated AWS (PAWSS ≥4).
• Patients were randomized to receive either a fixed-dose gabapentin taper or standard CIWA-directed benzodiazepine treatment.
• Primary outcome was length of stay (LOS); secondary outcomes included seizures, delirium tremens, ICU transfer, and patient-reported symptoms.

Main Results:

• Length of stay was shorter in the gabapentin group, but the difference was not statistically significant.
• No significant differences were observed in secondary outcomes such as seizures, delirium tremens, or ICU transfers.
• While not statistically significant, the gabapentin group received less than half the mean amount of benzodiazepines compared to the benzodiazepine group.

Conclusions:

• Fixed-dose gabapentin offers comparable outcomes to benzodiazepines for mild/moderate hospitalized AWS.
• Study interpretation is limited by under-enrollment and pre-randomization benzodiazepine administration in both groups.
• Gabapentin may be a viable alternative, but further investigation is warranted.