Gabapentin Combined With Naltrexone for the Treatment of Alcohol Dependence

• Published in: The American journal of psychiatry 2011-07, Vol.168 (7), p.709-717
• Main Authors: Anton, Raymond F., Myrick, Hugh, Wright, Tara M., Latham, Patricia K., Baros, Alicia M., Waid, L. Randolph, Randall, Patrick K.
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Alcohol Drinking - psychology; Alcohol use; Alcoholism; Alcoholism - drug therapy; Alcoholism - psychology; Alcoholism and acute alcohol poisoning; Amines - therapeutic use; Biological and medical sciences; Cyclohexanecarboxylic Acids - therapeutic use; Drug Administration Schedule; Drug therapy; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Naltrexone - administration & dosage; Naltrexone - therapeutic use; Narcotic Antagonists - therapeutic use; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Secondary Prevention; Substance abuse treatment; Substance Withdrawal Syndrome - prevention & control; Toxicology; Treatment Outcome
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2011.10101436

Objective:Naltrexone, an efficacious medication for alcohol dependence, does not work for everyone. Symptoms such as insomnia and mood instability that are most evident during early abstinence might respond better to a different pharmacotherapy. Gabapentin may reduce these symptoms and help prevent early relapse. This clinical trial evaluated whether the combination of naltrexone and gabapentin was better than naltrexone alone and/or placebo during the early drinking cessation phase (first 6 weeks), and if so, whether this effect persisted. Method:A total of 150 alcohol-dependent individuals were randomly assigned to a 16-week course of naltrexone alone (50 mg/day [N=50]), naltrexone (50 mg/day) with gabapentin (up to 1,200 mg/day [N=50]) added for the first 6 weeks, or double placebo (N=50). All participants received medical management. Results:During the first 6 weeks, the naltrexone-gabapentin group had a longer interval to heavy drinking than the naltrexone-alone group, which had an interval similar to that of the placebo group; had fewer heavy drinking days than the naltrexone-alone group, which in turn had more than the placebo group; and had fewer drinks per drinking day than the naltrexone-alone group and the placebo group. These differences faded over the remaining weeks of the study. Poor sleep was associated with more drinking in the naltrexone-alone group but not in the naltrexone-gabapentin group, while a history of alcohol withdrawal was associated with better response in the naltrexone-gabapentin group. Conclusions:The addition of gabapentin to naltrexone improved drinking outcomes over naltrexone alone during the first 6 weeks after cessation of drinking. This effect did not endure after gabapentin was discontinued.