Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
Research ArticleTools for Practice

Gabapentin for alcohol use disorder

Justin Weresch, Jessica Kirkwood and Christina S. Korownyk
Canadian Family Physician April 2021, 67 (4) 269; DOI: https://doi.org/10.46747/cfp.6704269
Justin Weresch
Family physician at McMaster Family Practice in Hamilton, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jessica Kirkwood
Family physician at Boyle McCauley Health Centre in Edmonton, Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christina S. Korownyk
Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

Clinical question

Is gabapentin an effective treatment for alcohol use disorder (AUD)?

Bottom line

Gabapentin treatment avoided more heavy drinking days (> 5 standard drinks/day) than placebo (27% vs 9%). Gabapentin can be a second-line, off-label option to treat AUD. However, there is mixed evidence and concerns about abuse-misuse, and drug-related harms.

Evidence

Results are statistically significant unless indicated.

  • A meta-analysis1 (7 RCTs; 3 to 26 weeks; N = 730) compared daily gabapentin doses of 300 to 3600 mg with placebo for treatment of AUD; most included regular follow-up visits after about 3 days of abstinence.

    -Gabapentin decreased the percentage of heavy drinking days (no absolute numbers reported). There was no difference in total abstinence. The gabapentin group had 10% more adverse events (AEs; no serious AEs reported).

  • An RCT2 comparing gabapentin to placebo (90 patients; mean age of 50 years; 77% male; average of 11 drinks/day) used an objective urine test to confirm drinking or abstinence. For 16 weeks, 1200 mg of gabapentin daily increased the number of no heavy drinking days (27% vs 9% placebo; number needed to treat [NNT] of 6). Total abstinence increased (18% gabapentin vs 4% placebo; NNT = 8). Patients with more alcohol withdrawal symptoms benefited more. Dizziness was an AE (56% gabapentin vs 33% placebo; number needed to harm of 4).

Context

  • Gabapentin can be a second-line, off-label treatment for moderate to severe AUD.3 Recommended as first-line are acamprosate (NNT = 12) and naltrexone (NNT = 20).3,4

  • Gabapentin misuse in the general population is about 1%, and up to 15% to 22% in patients with a history of opioid abuse. Risk with alcohol abuse history is less clear.5

  • Gabapentin-related cases reported to US poison control centres increased by 72% between 2013 and 2017, including a 120% increase in abuse-misuse and an 80% increase in suicidality.6

  • Patients prescribed gabapentin for any reason had double the death rate of the general population (relative risk of 2.16), and might be at higher baseline risk.7 Excess alcohol also increases mortality.8

  • Clinicians should be aware of potential misuse-diversion when prescribing gabapentin.9

Implementation

About 20% of Canadians aged 15 years or older will have AUD.10 Risky drinking is associated with higher rates of premature death, disability, comorbidity, reduced productivity, and financial burden to both the individual and society (eg, impaired driving, family conflict, and health care costs).11 The benefits of treatment need to be weighed against the harms of the condition. Take caution in those with a history of substance use disorder and coprescribed opioids.12

Notes

Tools for Practice articles in Canadian Family Physician are adapted from articles published on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in Canadian Family Physician are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician and are peer reviewed. Feedback is welcome and can be sent to toolsforpractice{at}cfpc.ca. Archived articles are available on the ACFP website: www.acfp.ca.

Footnotes

  • Competing interests

    None declared

  • The opinions expressed in Tools for Practice articles are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.

  • This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.

  • La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro d’avril 2021 à la page e104.

  • Copyright© 2021 the College of Family Physicians of Canada

References

  1. 1.↵
    1. Kranzler HR,
    2. Feinn R,
    3. Morris P,
    4. Hartwell EE.
    A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction 2019;114(9):1547-55. Epub 2019 Jun 5.
    OpenUrl
  2. 2.↵
    1. Anton RF,
    2. Latham P,
    3. Voronin K,
    4. Book S,
    5. Hoffman M,
    6. Prisciandaro J, et al.
    Efficacy of gabapentin for the treatment of alcohol use disorder in patients with alcohol withdrawal symptoms: a randomized clinical trial. JAMA Intern Med 2020;180(5):728-36.
    OpenUrl
  3. 3.↵
    Clinical care guidance. Vancouver, BC: British Columbia Centre on Substance Use; 2020. Available from: https://www.bccsu.ca/clinical-care-guidance. Accessed 2021 Mar 8.
  4. 4.↵
    1. Finley CR,
    2. Rumley C,
    3. Korownyk CS.
    Pharmacologic treatment of alcohol use disorder. Can Fam Physician 2020;66:583 (Eng), e216-7 (Fr).
    OpenUrlFREE Full Text
  5. 5.↵
    1. Smith RV,
    2. Havens JR,
    3. Walsh SL.
    Gabapentin misuse, abuse and diversion: a systematic review. Addiction 2016;111(7):1160-74. Epub 2016 Mar 18.
    OpenUrl
  6. 6.↵
    1. Reynolds K,
    2. Kaufman R,
    3. Korenoski A,
    4. Fennimore L,
    5. Shulman J,
    6. Lynch M.
    Trends in gabapentin and baclofen exposures reported to U.S. poison centers. Clin Toxicol (Phila) 2020;58(7):763-72. Epub 2019 Dec 1.
    OpenUrl
  7. 7.↵
    1. Torrance N,
    2. Veluchamy A,
    3. Zhou Y,
    4. Fletcher EH,
    5. Moir E,
    6. Hebert HL, et al.
    Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. Br J Anaesth 2020;125(2):159-67. Epub 2020 Jun 19.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Di Castelnuovo A,
    2. Costanzo S,
    3. Bagnardi V,
    4. Donati MB,
    5. Lacoviello L,
    6. de Gaetano G.
    Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 2006;166(22):2437-45.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Lennox R,
    2. Mangin D.
    Gabapentin misuse. CMAJ 2019;191(2):E47.
    OpenUrlFREE Full Text
  10. 10.↵
    1. Statistics Canada
    . Mental health and substance use disorders in Canada. Ottawa, ON: Government of Canada; 2013. Available from: https://www150.statcan.gc.ca/n1/en/pub/82-624-x/2013001/article/11855-eng.pdf?st=I1-2m0Ky. Accessed 2021 Mar 9.
  11. 11.↵
    1. Public Health Agency of Canada
    . The Chief Public Health Officer’s report on the state of public health in Canada, 2015: alcohol consumption in Canada. Ottawa, ON: Government of Canada; 2015. Available from: https://www.canada.ca/en/public-health/services/publications/chief-public-health-officer-reports-state-public-health-canada/2015-alcohol-consumption-canada.html. Accessed 2021 Mar 9.
  12. 12.↵
    1. Gomes T,
    2. Juurlink DN,
    3. Antoniou T,
    4. Mamdani MM,
    5. Paterson JM,
    6. van den Brink W.
    Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case-control study. PLoS Med 2017;14(10):e1002396.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Family Physician: 67 (4)
Canadian Family Physician
Vol. 67, Issue 4
1 Apr 2021
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Gabapentin for alcohol use disorder
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Gabapentin for alcohol use disorder
Justin Weresch, Jessica Kirkwood, Christina S. Korownyk
Canadian Family Physician Apr 2021, 67 (4) 269; DOI: 10.46747/cfp.6704269

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Gabapentin for alcohol use disorder
Justin Weresch, Jessica Kirkwood, Christina S. Korownyk
Canadian Family Physician Apr 2021, 67 (4) 269; DOI: 10.46747/cfp.6704269
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Clinical question
    • Bottom line
    • Evidence
    • Context
    • Implementation
    • Notes
    • Footnotes
    • References
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • La gabapentine pour les troubles liés à la consommation d’alcool
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Water for weight loss
  • Topical combination products for facial acne
  • Budesonide bests COVID-19
Show more Tools for Practice

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2022 by The College of Family Physicians of Canada

Powered by HighWire