Impact of Gabapentin as a Benzodiazepine-Sparing Medication During Acute Alcohol Withdrawal

Abrupt cessation of alcohol consumption after prolonged periods of use leaves patients at risk for experiencing withdrawal symptoms. Alcohol is a central nervous system depressant that increases the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and suppresses the activity of the excitatory neurotransmitter glutamate. Stopping consumption of alcohol reduces this inhibitory response and leads to a net excitatory state and symptoms of withdrawal, including anxiety, tremors, and even seizures. Benzodiazepines have traditionally been the treatment of choice for patients with alcohol withdrawal. Gabapentin has recently been studied as an adjunctive agent for the treatment and prevention of alcohol withdrawal, given its structural similarity to GABA and lower risk for dependence compared with benzodiazepines.

The primary objective of this study was to determine if a gabapentin-based regimen is benzodiazepine-sparing in patients experiencing alcohol withdrawal.

This was a retrospective, single center, pre- and post-implementation analysis of a gabapentin taper-based alcohol withdrawal protocol in place of a traditional benzodiazepine-based protocol used in patients admitted to a large, urban academic medical center in the Midwest for alcohol withdrawal between January 1, 2017, and January 1, 2023. The primary outcome was a comparison of cumulative benzodiazepine dose (in lorazepam equivalents) received throughout admission between groups.

This study included 200 patients with 100 patients in each of the pre- and post-implementation groups. Baseline characteristics were similar between groups except for baseline serum alcohol level, which was higher in the pre-implementation group. Patients in the post-implementation group on average were exposed to 9.7-mg lorazepam equivalents during admission compared with 22.8-mg lorazepam equivalents in the pre-implementation group (p = 0.001). Patients between groups had similar symptom progression as characterized by average daily alcohol withdrawal assessment scale (AWAS) scores and length of stay.

Utilization of a gabapentin taper resulted in significantly lower cumulative exposure to benzodiazepines and similar clinical outcomes in patients admitted for acute alcohol withdrawal.