- A new study reports the nerve pain reliever gabapentin may be helpful in treating people with serious alcohol withdrawal symptoms.
- Some experts say gabapentin is most effective if used in combination with a benzodiazepine medication.
- Gabapentin can have serious side effects, including drowsiness and abnormal eye movements.
Can a drug used primarily to treat nerve pain and partial seizures be effective in helping ease alcohol withdrawal symptoms?
Gabapentin is known under brand names such as Neurontin, Gralise, and Horizant.
The drug was originally used as a muscle relaxer and antispasmodic medication. It’s been used off-label for other conditions.
“It has been used for detoxification — alcohol withdrawal — for many years,” said Dr. Raymond F. Anton, the study’s main author and a professor of medicine at the Medical University of South Carolina in Charleston.
“For relapse prevention, other clinical trials have had mixed results. We had published several studies suggesting it would be added to other medications with some success, but it looked like only in those with alcohol withdrawal symptoms prior to treatment,” he said.
“This study proved that gabapentin could work by itself as a relapse prevention medication, but only in this with the higher alcohol withdrawal symptoms, as predicted,” Anton told Healthline.
Anton’s team looked at 90 people meeting the criteria of serious alcohol use.
Over 16 weeks, 12 of the 44 participants given gabapentin had no heavy drinking days (27 percent) compared with four (9 percent) of those participants given a placebo.
The study found mild to moderate side effects, including dizziness and some fatigue.
“Very few people had significant enough side effects to stop treatment,” Anton said. “It also improved sleep.”
Dr. Meredith Sagan, an addiction psychiatrist at Alo House Recovery Centers in Southern California, says gabapentin is most effective with benzodiazepine medications commonly used for withdrawal.
“Gabapentin cannot necessarily be used safely on its own to support such a detox,” Sagan told Healthline. “It’s always important to consult a medical professional when considering detoxifying from alcohol, as it can be very dangerous due to possible seizure and others risks.”
Sagan says the combination of medications and the timeline to take them is specific to each individual.
“Some people may need more or less medication, as well as different types and combinations, depending on their degree of alcohol consumption, in addition to other factors,” she said.
“So, although gabapentin can be a useful adjunct to the benzodiazepine category of medication for alcohol detox, it is not time to say goodbye to ‘benzos’ just yet,” Sagan said.
Benzodiazepines are also used to treat anxiety and seizures as well as to relax muscles. These medications come in many manufactured forms, including Xanax, Klonopin, Librium, Valium, and Ativan.
Participants in the South Carolina study weren’t allowed to take benzodiazepines or opioids.
“For people using gabapentin just for anxiety and not for alcohol withdrawal, gabapentin can be a good non-benzodiazepine alternative,” Sagan said.
“Gabapentin at higher doses can cause an uncomfortable withdrawal when one quits taking it. However, for some people with an addiction history, gabapentin is a safe alternative to benzodiazepines, which over the long term can be physically and psychologically addictive,” she said.
Common side effects of gabapentin include abnormal eye movements, clumsiness or unsteadiness, constipation, diarrhea, difficulty speaking, drowsiness, dry mouth, nausea, and vomiting.
More serious side effects — which may be more common in people with psychiatric disorders — include anger and violent behavior, increased anxiousness, depression, anxiety or irritability, mania, panic attacks, suicidal thoughts or behavior, and insomnia.
“I was prescribed gabapentin when I was struggling with my severely herniated disc,” Janine McKavish Thalblum, a resident of Dublin, California, told Healthline.
“The side effects were longer than an encyclopedia. With all the pain I was in I was borderline suicidal, so I opted not to take them, as that was one of the side effects. When the pharmacist was reading (them) before handing it over, I literally started to cry,” she explained.
Thalblum did take gabapentin for 2 days before opting out. She says she couldn’t tell if the medication contributed to her “overwhelming sense of wanting to give up.”
Andrea Johnson, a resident of Oakland, California, and her late wife, Julie, both took gabapentin for pain. They had vastly different experiences.
“She had chronic pain from her legs having been shattered in a car crash. Her doctors prescribed gabapentin about 10 years ago under its brand name of Neurontin,”
Johnson told Healthline.
“She stopped it after a week because it put her into a constant dream state. She was sort of awake and could do things but without being conscious of what she was doing. When I caught her rolling a cigarette without realizing that she was doing it, I put a stop to the gabapentin and told her doctor why,” Johnson said.
Johnson’s doctor prescribed her gabapentin last year for arthritis in her hips.
“I was concerned about it because of Julie’s experience, but I didn’t get the psych effects that she did,” Johnson said. “By the end of a month, it still wasn’t having an effect on my pain either, so I stopped it.”
In recent years, gabapentin has been involved in opioid overdose deaths and been dubbed “an emerging threat” in a national bulletin to law enforcement.
It’s listed as a controlled substance in some states, although officials say it’s usually not the main cause of death and not as dangerous as opioids.
Pfizer, which developed gabapentin, paid $430 million in 2004 under an agreement with government prosecutors over fraudulent claims the company was accused of making about the drug’s uses.
Anton says researchers are still looking at whether gabapentin can be used as an anti-craving drug like naltrexone.
“Right now, it is estimated that only 20 percent of individuals who might benefit from reducing or stopping drinking actually receive treatment,” Anton said.
“And, of those 20 percent, only 20 percent receive any medication-assisted treatment. The standard of care in the U.S. has historically been an AA (Alcohol Anonymous) or 12-step counseling model. While that model has helped many people, many others do not want to partake in it, or haven’t found it useful.
“Medications that can be prescribed by specialized and/or primary care providers can encourage many more people to consider treatment for their alcohol use disorder,” he added.