Gabapentin for Alcohol Use Disorder

How Does Gabapentin Work?

Gabapentin reduces anxiety in many people who take it, and also controls the worst side effects of alcohol detox. It is especially useful for people for whom anxiety is a drinking trigger, or who are likely to experience acute withdrawal symptoms. It can make it easier to get started on other medications by smoothing out the transition period, and can be a good substitute for people who don’t react well to naltrexone.

Gabapentin works by “remodeling” your synapses, or nerve-to-nerve connections. This explains its use in treating nerve-related pain such as shingles, as well as epileptic seizures. In fact, seizures are among the more extreme reactions people can have to alcohol withdrawal, and can be prevented by taking gabapentin.

For alcohol use disorder (AUD), gabapentin is considered “off-label.” An off-label medication is a drug indicated for one purpose, but prescribed for another because a doctor deems it safe and useful. In this case, gabapentin is FDA-indicated to treat epilepsy and shingles-related nerve pain, but has found many other applications.

How Do You Take Gabapentin for Alcohol Use Disorder?

Gabapentin is typically taken in the form of an oral capsule or tablet. Doses can vary based on a patient’s needs.

When taking medication for alcohol dependence, it’s important to be under the supervision of a doctor who can monitor what works best for you. You shouldn’t take gabapentin for alcohol use disorder on your own.

Controversy and Supporting Evidence

Gabapentin is not without its controversies. After its initial approval, gabapentin’s manufacturer got in trouble for marketing it for a range of off-label purposes without enough supporting evidence. More recently, the opioid epidemic has motivated many doctors to prescribe gabapentin as an alternative painkiller, which has also been met with some criticism. There are reasons, therefore, to be skeptical of non-FDA indicated uses of gabapentin.

However, many off-label uses of this drug are well-founded and supported by clinical trials. FDA approvaled indications of gabapentin for both shingles treatment and restless leg syndrome have happened more recently. And in the case of alcohol addiction, there is increasing evidence to support gabapentin’s effectiveness:

• One study in 2007 demonstrated that people who took gabapentin had more days of abstinence—and drank less alcohol on days when they did drink—than those who took a placebo.
• A 2011 study showed that gabapentin and naltrexone in combination had a bigger impact for people in the first 6 weeks of treatment than naltrexone alone.
• Finally, a study in 2014 showed that 900-1800 mg of gabapentin per day was two to four times as effective in maintaining abstinence compared with placebo, and nearly twice as effective for reducing heavy drinking.

Although gabapentin has yet to receive an FDA indication for treating alcohol use disorder, it does seem to be both effective and safe for this purpose. Already, it has appeared on the American Psychiatric Association’s list of suggested medications for AUD.5

Gabapentin and Naltrexone

Gabapentin can be a good alternative for people who haven’t responded well to naltrexone, but the two drugs can also be combined with positive results. A 2012 study compared those who took naltrexone alone to those that took a naltrexone-gabapentin combination. Researchers found that the combination was more effective in helping delay heavy drinking, reduce heavy drinking days, and reduce the number of drinks.

Combining gabapentin and naltrexone may also help counteract some naltrexone side effects, such as insomnia and mood problems. Finally, gabapentin can ease initial alcohol withdrawal symptoms and make it easier for people to transition to daily naltrexone.

You should never combine naltrexone and gabapentin without consulting a medical professional first. But the combination is worth looking into if you’ve struggled with naltrexone alone.

Side Effects of Gabapentin

Dizziness is the most commonly reported side effect of gabapentin. If you experience unusual clumsiness, or rapid, uncontrollable eye movements, you should consult a doctor immediately. Less serious side effects include:

• Weakness
• Blurry vision
• Cold or flu-like symptoms
• Tremors
• Lower back pain

There are reports that gabapentin can produce suicidal thoughts in some people. Other studies show no increase in suicidal behavior, and even show improvement in some patients. Regardless, if a person has a history of suicidal feelings they should discuss this with a doctor before starting this medication.

There has also been some discussion about whether gabapentin can produce dependence. Some people report abusing the medication, while others have reported withdrawal symptoms. Most of these cases occur in opiate-dependent people. While gabapentin doesn’t seem to pose the same risk of addiction as opioids, it’s important to stick to the recommended dose, and it’s generally best to taper off the medication when you stop.

Finally, because gabapentin is processed renally, it may cause problems if you have kidney disease. In all cases, you should talk to your doctor before taking this medication.

Is Gabapentin For You?

Gabapentin May Be Helpful If:

• Chronic anxiety motivates your drinking
• You expect severe withdrawal symptoms
• You are on opioid pain medications and cannot take naltrexone
• You experience insomnia
• You drink first thing in the morning to alleviate alcohol withdrawal symptoms (i.e. severe shaking, nausea/vomiting, or even for a severe hangover).

Gabapentin May Not Be Best If:

• You are at risk for abusing prescription pain medication
• You have kidney disease
• You have a history of uncontrolled depression or suicidal thoughts

Overall, gabapentin is safe for most people to take. Side effects are uncommon, and it has few negative interactions with other drugs. It doesn’t interfere with opioid pain medication, as naltrexone does. And as a treatment for withdrawal symptoms, it has a lower risk of dependence than benzodiazepines like Valium and Xanax. It can serve as a bridge to another medication by helping you through detox more easily. Finally, as a generic medication, gabapentin is relatively cheap and comes in a wide range of dose sizes, making treatment easy to customize.

On the other hand, gabapentin is slower to show results than some other medications. It can take one to two months before you know if it’s helping. In the meantime, this medication has a somewhat sedative effect, which is troubling for some people who take it. Finally, although less risky than some other medications, there have been reports of people abusing gabapentin, or experiencing withdrawal when they stop taking it.

In summary, gabapentin is a good first-line medication for people with anxiety or low tolerance for naltrexone, and a good second-line medication in many other cases. People who struggle with alcohol addiction are twice as likely to suffer from an anxiety disorder, and withdrawal symptoms from alcohol can be severe. If either or both of these are a major concern for you, gabapentin may be the right medication to help you reduce or stop drinking.

OTHER MEDICATIONS

Naltrexone | Disulfiram/Antabuse | Acamprosate | Baclofen | Topiramate