Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Abstract

Background Benzodiazepine (BZD) use disorders are a common clinical problem among methadone maintenance treatment patients and have adverse effects on clinical outcomes. Objectives To evaluate gabapentin for the outpatient treatment of BZD abuse or dependence in methadone maintenance patients. Methods Participants (n=19) using BZDs at least 4 days per week were enrolled into an eight-week randomized double-blind placebo-controlled outpatient pilot trial. All participants received a manual-guided supportive psychotherapy aimed to promote abstinence. Study medication was titrated over a two-week period to a maximum dose of gabapentin 1200 mg or placebo three times a day. BZD use was assessed using urine toxicology confirmed self-report. BZDs were not provided as part of study participation; participants were provided guidance to gradually reduce BZD intake. Results Sixteen participants had post-randomization data for analysis. Retention at week eight was 50%. The mean dose of gabapentin achieved by titration was 2666 mg/day (SD=±1446). There were no significant between group differences on BZD use outcomes (amount BZD per day (Mann-Whitney U = 27, p = .745), abstinent days per week (U = 28, p = .811)) and CIWA-BZD scale (U = 29.0, p = .913). One participant in the gabapentin group discontinued study medication because of peripheral edema. Two participants in the placebo group requested admission for inpatient detoxification treatment. Conclusion Gabapentin was not found to differ from placebo, although the small sample recruited for this trial may have limited the ability to detect a difference.

Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation

“…Participants ( n = 19) were enrolled in either a placebo arm or a gabapentin arm. 44 The study concluded that no difference was noted in patients on gabapentin compared with placebo. Despite gabapentin being able to increase GABA concentrations, no benefit was found in this study.…”

Pharmacological class interventions for benzodiazepine withdrawal discontinuation: a meta-analysis

“…1). In total, forty-nine controlled clinical trials were selected and included in this meta-analysis after two suitable one (29,30) were removed because we could not extract enough data, in conformity to the measures of treatment effect that we opted to perform statistical analysis. The trials involved 2724 assigned participants (allocated or completers):1384 participants in the active medication group and 1340 in the placebo group, another group or a control group(non-placebo) (Table 1).…”

Therapie der Benzodiazepinabhängigkeit

“…Für Suchterkrankungen insgesamt liegen zahlreiche Therapiestudien vor [39], [44], [45], [46], für Benzodiazepine und BZD-Abhängigkeit allerdings relativ wenige.…”

“…Andere Alternativen sind Non-Benzodiazepin-Anxiolytika, Pregabalin, Gabapentin und Betablocker [40], [44]. Gabapentin hat zwar selber ein gewisses Suchtpotenzial, scheint aber eine gewisse Wirkung beim Benzodiazepinentzug zu habenjedenfalls wäre bei Patienten mit Angstsymptomatik an eine solche Behandlung zu denken.…”