Impact of Gabapentin as a Benzodiazepine-Sparing Medication During Acute Alcohol Withdrawal.
Level 4 - case-series / case-control
Retrospective pre- and post-implementation study with historical controls
PubMed 41218601 · doi:10.1002/phar.70074
What was done
A retrospective, single-center, pre- and post-implementation study evaluated the transition from a standard benzodiazepine protocol to a gabapentin taper-based protocol for acute alcohol withdrawal. The cohort included 200 patients (100 pre-implementation, 100 post-implementation) admitted to an urban academic medical center between January 1, 2017, and January 1, 2023. The primary outcome was cumulative inpatient benzodiazepine dose in lorazepam equivalents. Secondary outcomes included symptom progression assessed by average daily Alcohol Withdrawal Assessment Scale (AWAS) scores and hospital length of stay.
What was found
Patients in the post-implementation gabapentin group received significantly lower cumulative benzodiazepine doses compared with the pre-implementation group (mean 9.7 mg vs. 22.8 mg lorazepam equivalents, p = 0.001). Average daily AWAS scores and hospital length of stay were reported as similar between groups, though exact numbers were not reported in the abstract. Baseline serum alcohol level was higher in the pre-implementation cohort.
Why it matters
Incorporating a structured gabapentin taper into alcohol withdrawal management significantly decreases cumulative benzodiazepine exposure while maintaining comparable symptom control and hospital stay duration.
Limits
The retrospective pre-post design with historical controls introduces potential temporal confounding and practice variation over time. Baseline serum alcohol concentration was higher in the pre-implementation group, which may have contributed to greater initial benzodiazepine needs. Conducted at a single medical center. Numerical data for AWAS scores and length of stay, as well as rates of severe withdrawal complications (such as delirium tremens or seizures) and adverse drug events, were not reported in the abstract.
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