Gabapentin for Alcohol Withdrawal: What You Need To Know

Alcohol withdrawal is common in those who’ve quit drinking after a period of chronically heavy consumption and/or dependence. Symptoms can range from mild discomforts to more severe physical and emotional disruptions. For those undergoing alcohol withdrawal, medical interventions can alleviate symptoms, help the body overcome cravings, and allow them to successfully quit drinking.

Gabapentin has emerged as a potential treatment for mild withdrawal symptoms. This prescription medication has shown promising effects in improving withdrawal symptoms, but it’s not for everyone. 

Read on to learn more about gabapentin and alcohol withdrawal. You’ll discover how the drug works, whether it’s something to bring up with your doctor, and what its potential interactions with alcohol are.

What Is Gabapentin?

Gabapentin, also known by the brand names Horizant, Gralise, and Neurontin, is a prescription drug. This medication is one of the most commonly prescribed in the U.S. It can treat seizures, nerve pain after shingles, and restless leg syndrome. There are also several off-label uses, including one for treatment of alcohol withdrawal (along with cravings, alcohol-related anxiety, and insomnia). 

This medication is classified as an anticonvulsant due to its role as a gamma-aminobutyric acid (GABA) analogue. GABA, a neurotransmitter, decreases the excitability within the brain’s neurons. These neurons, or nerve cells, play a key role in seizures and transmitting pain signals. Gabapentin essentially mimics GABA’s effects, calming these excited neurons.  

Using Gabapentin for Alcohol Withdrawal

It’s important to note that while gabapentin has been deemed effective for alcohol withdrawal, that applies only to mild alcohol withdrawal. In such cases, it can be an effective therapeutic modality — especially when used with other medications — for alleviating certain symptoms:

• Impulses to drink alcohol, particularly in the early stages of abstinence
• Alcohol cravings
• Mood issues
• Anxiety
• Insomnia
• Potential for relapse 

Studies on Gabapentin for Alcohol Withdrawal

Research indicates that gabapentin should be prescribed solely in cases where other treatments have been ineffective and only for those who aren’t at risk for abusing prescription, illicit, or opioid drugs. 

When it comes to alcohol withdrawal, benzodiazepines are a standard treatment method. These drugs calm the central nervous system and may prevent delirium tremens (DTs) and seizures. However, due to their heavy sedative effects, they may cause motor impairments, which can be dangerous in professional settings and on the road. Furthermore, benzodiazepines have a high risk of addiction, so they’re typically only used in the early stages of alcohol withdrawal. 

Gabapentin doesn't carry as much risk of addiction and can offer many of the same benefits as benzodiazepines. However, research on gabapentin for alcohol withdrawal is mixed.

Inpatient Clinical Trials

A study undertaken at a South Carolina psychiatric hospital evaluated the effectiveness of gabapentin in conjunction with benzodiazepines for treating alcohol withdrawal. This study compared two groups: one group of 40 patients received gabapentin along with a benzodiazepine-based alcohol withdrawal protocol, while the control group of 43 patients followed the protocol without gabapentin. Based on the results, gabapentin did not show any significant benefits. 

In another inpatient study, conducted in 2010, a team of German researchers explored gabapentin's potential role in treating severe inpatient alcohol withdrawal. This study examined 37 patients who scored high on the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar). Each patient took 800 mg of gabapentin; 27 patients showed improvements in symptoms within two hours and were labeled “early responders.” They continued to take a particular gabapentin dose for two more days before tapering off. Meanwhile, 10 participants didn’t respond at all to the gabapentin and actually had worsening symptoms, so they were shifted to standard treatments. It’s important to also mention that three early responders actually underwent symptom exacerbation later on, with two of them experiencing seizures. Based on all of the above, the researchers concluded that high gabapentin doses (3,200 mg in the first 24 hours) are only effective for milder alcohol withdrawal cases. 

Outpatient Clinical Trials

A 2009 study in Alcoholism: Clinical and Experimental Research focused on 100 outpatients seeking treatment for alcohol withdrawal. These patients were divided into four groups to compare the effects of different doses of gabapentin (600 mg, 900 mg, 1,200 mg) and lorazepam (6 mg), each with a four-day tapering window. The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) was used to measure effectiveness. (Only 68 patients completed the follow-up until day 12, however). Based on the final results, gabapentin, specifically at 1,200 mg, was deemed to be effective in reducing alcohol withdrawal symptoms, particularly anxiety and cravings, and was better tolerated than lorazepam. Lorazepam users had a higher relapse risk and were more likely to continue drinking once treatment concluded. 1,200 mg of gabapentin also showed benefits in improving sleep, reducing anxiety, and enhancing work capability, while the 900 mg dosage was linked to less depression compared to lorazepam.

In another study in Annals of Pharmacotherapy, researchers conducted a randomized, double-blind study on 26 military veterans. This study specifically compared gabapentin and chlordiazepoxide in treating acute alcohol withdrawal in an outpatient setting. Patients received either gabapentin (1,200 mg initially, tapering to 300 mg) or chlordiazepoxide (100 mg initially, tapering to 25 mg). Based on the results, there were initial improvements in withdrawal scores for both groups, but the gabapentin group had better outcomes in terms of sleep and cravings in the later stages. Additionally, gabapentin triggered fewer sedative effects when compared to chlordiazepoxide.

Gabapentin Side Effects

While gabapentin can certainly be advantageous, it’s not without side effects. Here are some common ones: 

• Allergic reactions
• Dizziness
• Drowsiness
• Headaches
• Weakness
• Anxiety
• Depression
• Memory issues
• Swelling
• Constipation
• Diarrhea
• Acid reflux
• Weight gain
• Seizures

Stopping gabapentin without gradually tapering can lead to withdrawal symptoms, which may include sweating, pain, nausea, and vomiting. Always take gabapentin as prescribed to avoid any adverse issues. 

Gabapentin Interactions With Alcohol

Mixing alcohol and gabapentin is inadvisable. It’s important to understand the potential interactions, and the dangers shouldn’t be overlooked. 

Mixing gabapentin with alcohol may amplify effects of both substances, since they’re both central nervous system depressants. 

This combination may increase symptoms such as dizziness, drowsiness, and concentration difficulties. Some people may even notice impaired judgment and thinking. Furthermore, sedation may occur, which can be particularly harmful if someone is operating machinery or driving. 

Finally, gabapentin and alcohol use may trigger respiratory depression. In this situation, a person experienced slowed or labored breathing, which may be fatal in certain instances.

So, can you drink alcohol with gabapentin? The answer is no! If you’re consuming alcohol regularly and have been prescribed gabapentin, please consult your physician immediately. To avoid adverse risks, it’s essential to change your drinking habits, which can be done with the help of apps such as Reframe. If alcohol-gabapentin interactions are likely, your physician may prescribe a medication with a lower risk of contraindications. 

Alcohol and Gabapentin: The Takeaways

If you’re in the early stages of alcohol withdrawal, and your symptoms are mild, gabapentin may be an effective treatment method. This medication has been shown to alleviate common symptoms such as cravings, insomnia, and anxiety. However, gabapentin is not for everyone, and further research is needed to determine its efficacy, particularly in inpatient settings.

Talk to your doctor about potential treatment methods for alcohol withdrawal, including gabapentin, to see what’s best for you. Remember that with the right support, a speedy recovery is possible!