Article

Gabapentin Combined With Naltrexone for the Treatment of Alcohol Dependence

Medical University of South Carolina, Institute of Psychiatry, SC 29425, USA.
American Journal of Psychiatry (Impact Factor: 13.56). 03/2011; 168(7):709-17. DOI: 10.1176/appi.ajp.2011.10101436
Source: PubMed

ABSTRACT Naltrexone, an efficacious medication for alcohol dependence, does not work for everyone. Symptoms such as insomnia and mood instability that are most evident during early abstinence might respond better to a different pharmacotherapy. Gabapentin may reduce these symptoms and help prevent early relapse. This clinical trial evaluated whether the combination of naltrexone and gabapentin was better than naltrexone alone and/or placebo during the early drinking cessation phase (first 6 weeks), and if so, whether this effect persisted.
A total of 150 alcohol-dependent individuals were randomly assigned to a 16-week course of naltrexone alone (50 mg/day [N=50]), naltrexone (50 mg/day) with gabapentin (up to 1,200 mg/day [N=50]) added for the first 6 weeks, or double placebo (N=50). All participants received medical management.
During the first 6 weeks, the naltrexone-gabapentin group had a longer interval to heavy drinking than the naltrexone-alone group, which had an interval similar to that of the placebo group; had fewer heavy drinking days than the naltrexone-alone group, which in turn had more than the placebo group; and had fewer drinks per drinking day than the naltrexone-alone group and the placebo group. These differences faded over the remaining weeks of the study. Poor sleep was associated with more drinking in the naltrexone-alone group but not in the naltrexone-gabapentin group, while a history of alcohol withdrawal was associated with better response in the naltrexone-gabapentin group.
The addition of gabapentin to naltrexone improved drinking outcomes over naltrexone alone during the first 6 weeks after cessation of drinking. This effect did not endure after gabapentin was discontinued.

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    • "Anton et al. (2009) reported that alcohol dependent patients who experienced pre-treatment withdrawal symptoms had fewer drinking days when treated with gabapentin in combination with flumazenil compared with placebo-treated patients. In addition, Anton et al. (2011) demonstrated that adding gabapentin to naltrexone for the treatment of patients with alcohol dependence resulted in fewer heavy drinking days than treatment with naltrexone alone. In a preliminary study, Arias et al. (2010) found that alcohol dependent patients treated with zonisamide had fewer heavy drinking days and consumed less drinks per week, compared with placebo. "
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