Use of a Gabapentin Protocol for the Management of Alcohol Withdrawal: A Preliminary Experience Expanding From the Consultation-Liaison Psychiatry Service

Jonathan G. Leung; Daniela B. Rakocevic; Nicholas D. Allen; Elliot M. Handler; Bruno A. Perossa; Kristin L. Borreggine; Amy L. Stark; Hannah K. Betcher; Daniel K. Hosker; Blaine A. Minton; Benjamin R. Braus; Ross A. Dierkhising; Kemuel L. Philbrick

doi:10.1016/j.psym.2018.03.002

Use of a Gabapentin Protocol for the Management of Alcohol Withdrawal: A Preliminary Experience Expanding From the Consultation-Liaison Psychiatry Service

Jonathan G. Leung, Daniela B. Rakocevic, Nicholas D. Allen, Elliot M. Handler, Bruno A. Perossa, Kristin L. Borreggine, Amy L. Stark, Hannah K. Betcher, Daniel K. Hosker, Blaine A. Minton, Benjamin R. Braus, Ross A. Dierkhising, Kemuel L. Philbrick

Psychiatry & Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: Benzodiazepines are the conventional mainstay to manage alcohol withdrawal; however, patients are subsequently at increased risk for poor sleep, cravings, and return to drinking. Research on alternative pharmacologic agents to facilitate safe alcohol withdrawal is scant. Gabapentin is one medication shown in small studies to reduce the need for benzodiazepines in the setting of alcohol withdrawal. The continuation of gabapentin after alcohol withdrawal appears to be safe during early sobriety and may aid in reducing alcohol-related cravings or returning to alcohol consumption. Use of a gabapentin-based, benzodiazepine-sparing protool began in early 2015 by the Mayo Clinic, Rochester, Consultation-Liaison Psychiatry Service. Objective: A retrospective chart review was conducted to detect any safety concerns with use of a gabapentin protocol for alcohol withdrawal syndrome. Methods: Secondary outcomes were derived by comparing a matched cohort of patients who received benzodiazepines for alcohol withdrawal syndrome. Results: Seventy-seven patients had their alcohol withdrawal managed via a gabapentin protocol during the study period. No patients required transfer to a higher level of care or had a documented withdrawal seizure. Length of stay between the gabapentin protocol group and benzodiazepine group were similar. Conclusion: This preliminary data has supported the frequent use of this protocol in the general internal medicine practice and formalization of an institutional order set of this protocol for mild to moderate alcohol withdrawal syndrome. Prospective studies are required to validate findings.

Original language	English (US)
Pages (from-to)	496-505
Number of pages	10
Journal	Psychosomatics
Volume	59
Issue number	5
DOIs	https://doi.org/10.1016/j.psym.2018.03.002
State	Published - Sep 1 2018

Bibliographical note

Funding Information:
Financial disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors of this paper have no sources of financial support or conflicts of interest relevant to this manuscript. Additional disclosure: Preliminary findings related to this manuscript have been submitted to the 66th Annual Meeting, Academy of Psychosomatic Medicine as an oral poster.

Publisher Copyright:
© 2018 Academy of Consultation-Liaison Psychiatry

Keywords

Alcohol
Alcohol withdrawal syndrome.
Craving
Dependence
Gabapentin
Withdrawal

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Leung, J. G., Rakocevic, D. B., Allen, N. D., Handler, E. M., Perossa, B. A., Borreggine, K. L., Stark, A. L., Betcher, H. K., Hosker, D. K., Minton, B. A., Braus, B. R., Dierkhising, R. A., & Philbrick, K. L. (2018). Use of a Gabapentin Protocol for the Management of Alcohol Withdrawal: A Preliminary Experience Expanding From the Consultation-Liaison Psychiatry Service. Psychosomatics, 59(5), 496-505. https://doi.org/10.1016/j.psym.2018.03.002

Leung, JG, Rakocevic, DB, Allen, ND, Handler, EM, Perossa, BA, Borreggine, KL, Stark, AL, Betcher, HK, Hosker, DK, Minton, BA, Braus, BR, Dierkhising, RA & Philbrick, KL 2018, 'Use of a Gabapentin Protocol for the Management of Alcohol Withdrawal: A Preliminary Experience Expanding From the Consultation-Liaison Psychiatry Service', Psychosomatics, vol. 59, no. 5, pp. 496-505. https://doi.org/10.1016/j.psym.2018.03.002

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abstract = "Background: Benzodiazepines are the conventional mainstay to manage alcohol withdrawal; however, patients are subsequently at increased risk for poor sleep, cravings, and return to drinking. Research on alternative pharmacologic agents to facilitate safe alcohol withdrawal is scant. Gabapentin is one medication shown in small studies to reduce the need for benzodiazepines in the setting of alcohol withdrawal. The continuation of gabapentin after alcohol withdrawal appears to be safe during early sobriety and may aid in reducing alcohol-related cravings or returning to alcohol consumption. Use of a gabapentin-based, benzodiazepine-sparing protool began in early 2015 by the Mayo Clinic, Rochester, Consultation-Liaison Psychiatry Service. Objective: A retrospective chart review was conducted to detect any safety concerns with use of a gabapentin protocol for alcohol withdrawal syndrome. Methods: Secondary outcomes were derived by comparing a matched cohort of patients who received benzodiazepines for alcohol withdrawal syndrome. Results: Seventy-seven patients had their alcohol withdrawal managed via a gabapentin protocol during the study period. No patients required transfer to a higher level of care or had a documented withdrawal seizure. Length of stay between the gabapentin protocol group and benzodiazepine group were similar. Conclusion: This preliminary data has supported the frequent use of this protocol in the general internal medicine practice and formalization of an institutional order set of this protocol for mild to moderate alcohol withdrawal syndrome. Prospective studies are required to validate findings.",

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note = "Funding Information: Financial disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors of this paper have no sources of financial support or conflicts of interest relevant to this manuscript. Additional disclosure: Preliminary findings related to this manuscript have been submitted to the 66th Annual Meeting, Academy of Psychosomatic Medicine as an oral poster. Publisher Copyright: {\textcopyright} 2018 Academy of Consultation-Liaison Psychiatry",

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AU - Allen, Nicholas D.

AU - Handler, Elliot M.

AU - Perossa, Bruno A.

AU - Borreggine, Kristin L.

AU - Stark, Amy L.

AU - Betcher, Hannah K.

AU - Hosker, Daniel K.

AU - Minton, Blaine A.

AU - Braus, Benjamin R.

AU - Dierkhising, Ross A.

AU - Philbrick, Kemuel L.

N1 - Funding Information: Financial disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors of this paper have no sources of financial support or conflicts of interest relevant to this manuscript. Additional disclosure: Preliminary findings related to this manuscript have been submitted to the 66th Annual Meeting, Academy of Psychosomatic Medicine as an oral poster. Publisher Copyright: © 2018 Academy of Consultation-Liaison Psychiatry

PY - 2018/9/1

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N2 - Background: Benzodiazepines are the conventional mainstay to manage alcohol withdrawal; however, patients are subsequently at increased risk for poor sleep, cravings, and return to drinking. Research on alternative pharmacologic agents to facilitate safe alcohol withdrawal is scant. Gabapentin is one medication shown in small studies to reduce the need for benzodiazepines in the setting of alcohol withdrawal. The continuation of gabapentin after alcohol withdrawal appears to be safe during early sobriety and may aid in reducing alcohol-related cravings or returning to alcohol consumption. Use of a gabapentin-based, benzodiazepine-sparing protool began in early 2015 by the Mayo Clinic, Rochester, Consultation-Liaison Psychiatry Service. Objective: A retrospective chart review was conducted to detect any safety concerns with use of a gabapentin protocol for alcohol withdrawal syndrome. Methods: Secondary outcomes were derived by comparing a matched cohort of patients who received benzodiazepines for alcohol withdrawal syndrome. Results: Seventy-seven patients had their alcohol withdrawal managed via a gabapentin protocol during the study period. No patients required transfer to a higher level of care or had a documented withdrawal seizure. Length of stay between the gabapentin protocol group and benzodiazepine group were similar. Conclusion: This preliminary data has supported the frequent use of this protocol in the general internal medicine practice and formalization of an institutional order set of this protocol for mild to moderate alcohol withdrawal syndrome. Prospective studies are required to validate findings.

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KW - Gabapentin

KW - Withdrawal

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Use of a Gabapentin Protocol for the Management of Alcohol Withdrawal: A Preliminary Experience Expanding From the Consultation-Liaison Psychiatry Service

Abstract

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Keywords

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