Gabapentin to treat acute alcohol withdrawal in hospitalized patients: A systematic review and meta-analysis

Mattle, Anna G.; McGrath, Patrick J.; Sanu, Austin; Kunadharaju, Rajesh; Kersten, Brian R.; Zammit, Kimberly; Mammen, Manoj J.

doi:10.1016/j.drugalcdep.2022.109671

Cited by 12 publications

(3 citation statements)

References 26 publications

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“… 64 It is also sometimes used with as-needed benzodiazepines for more severe withdrawal in the inpatient setting, but this approach has not been shown to be superior to benzodiazepines alone. 65 Gabapentin can also be continued after withdrawal treatment to prevent relapse but should be used with caution because of the sedating effect and the potential for misuse. 66 , 67 The 2020 ASAM guidelines state that carbamazepine or gabapentin can be used for “patients experiencing mild withdrawal who are at minimal risk of developing severe or complicated withdrawal” and that “carbamazepine, gabapentin, or valproic acid (if no liver disease or childbearing potential) may be used as an adjunct to benzodiazepines.” 54 …”

Section: Introductionmentioning

confidence: 99%

Management of alcohol withdrawal syndrome in patients with alcohol-associated liver disease

Ratner,

Blaney,

Rastegar

2024

Hepatology Communications

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Alcohol-associated liver disease is a common and severe sequela of excessive alcohol use; effective treatment requires attention to both liver disease and underlying alcohol use disorder (AUD). Alcohol withdrawal syndrome (AWS) can be dangerous, is a common barrier to AUD recovery, and may complicate inpatient admissions for liver-related complications. Hepatologists can address these comorbid conditions by learning to accurately stage alcohol-associated liver disease, identify AUD using standardized screening tools (eg, Alcohol Use Disorder Identification Test), and assess risk for and symptoms of AWS. Depending on the severity, alcohol withdrawal often merits admission to a monitored setting, where symptom-triggered administration of benzodiazepines based on standardized scoring protocols is often the most effective approach to management. For patients with severe liver disease, selection of benzodiazepines with less dependence on hepatic metabolism (eg, lorazepam) is advisable. Severe alcohol withdrawal often requires a “front-loaded” approach with higher dosing, as well as intensive monitoring. Distinguishing between alcohol withdrawal delirium and HE is important, though it can be difficult, and can be guided by differentiating clinical characteristics, including time to onset and activity level. There is little data on the use of adjuvant medications, including anticonvulsants, dexmedetomidine, or propofol, in this patient population. Beyond the treatment of AWS, inpatient admission and outpatient hepatology visits offer opportunities to engage in planning for ongoing management of AUD, including initiation of medications for AUD and referral to additional recovery supports. Hepatologists trained to identify AUD, alcohol-associated liver disease, and risk for AWS can proactively address these issues, ensuring that patients’ AWS is managed safely and effectively and supporting planning for long-term recovery.

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Section: Introductionmentioning

confidence: 99%

Management of alcohol withdrawal syndrome in patients with alcohol-associated liver disease

Ratner,

Blaney,

Rastegar

2024

Hepatology Communications

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“…However, there was a notable difference in the rate of symptom resolution favoring gabapentin-treated patients. Subgroup analyses, particularly for severe AWS patients, indicated a significant decrease in hospital length of stay and a reduction in benzodiazepine administration in gabapentin-treated patients [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder

Celik,

Gold,

Fuehrlein

2024

Brain Sciences

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Alcohol use disorder (AUD) is a significant contributor to morbidity and mortality in the United States. It contributes to over 140,000 annual deaths, to over 200 related diseases and health conditions globally, and accounts for 5.1% of the global disease burden. Despite its substantial impact, AUD remains undertreated, marked by a scarcity of approved medications. This paper explores the current treatment landscape and novel strategies for both alcohol withdrawal syndrome and AUD. Promising results, including the use of psychedelics alongside psychotherapy, noninvasive neural-circuit-based interventions, phosphodiesterase-4 inhibitors, and GLP-1 receptor agonists, have emerged from recent studies. While these advancements show potential, further research is crucial for a comprehensive understanding of their effectiveness. The clear shortage of approved medications and other treatment modalities underscores the pressing need for ongoing research.

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“…Here it is emphasized the concentration of ibuprofen and acetaminophen which are world-wide used anti-in ammatory and analgesic drugs respectively (Nunes et al 2014;Brillas 2022). Therefore, high concentrations of gabapentin (which is used for epileptic attacks) and losartan (reduce high arterial pressure) were found (Lin et al 2022;Mattle et al 2022). Even though the oncological hospital is close to the sampled area, there is no clear evidence in the results of an increase of chemotherapy pharmaceuticals present in this analytical method like capecitabine.…”

Section: Statistical Approach By Sampling Point and Datementioning

confidence: 99%

Assessing the pharmaceutical residues as hotspots of the main rivers of Catalonia, Spain

Domínguez-García,

Fernández-Ruano,

Báguena

et al. 2024

Preprint

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The global increase in pharmaceutical consumption, driven by factors such as aging populations and chronic diseases, has raised concerns regarding the environmental impact of pharmaceutical contaminants (ECs). Europe, notably Catalonia in Spain, exhibits high pharmaceutical consumption rates, potentially exacerbating environmental contamination. Pharmaceuticals enter rivers through various pathways, persisting through wastewater treatment plants and posing risks to aquatic organisms and human health. Llobregat and Besòs rivers in Catalonia, crucial water sources, demonstrate detectable pharmaceutical levels, necessitating comprehensive analysis. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) proves effective in detecting pharmaceutical residues, facilitating risk assessment. This paper reviews the occurrence, fate, and risks associated with 78 pharmaceuticals in Llobregat and Besòs rivers, utilizing HPLC-MS/MS for analysis. Understanding pharmaceutical impacts on Catalonian river ecosystems is essential for developing mitigation strategies.

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Gabapentin to treat acute alcohol withdrawal in hospitalized patients: A systematic review and meta-analysis

Cited by 12 publications

References 26 publications

Management of alcohol withdrawal syndrome in patients with alcohol-associated liver disease

Management of alcohol withdrawal syndrome in patients with alcohol-associated liver disease

A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder

Assessing the pharmaceutical residues as hotspots of the main rivers of Catalonia, Spain

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