Controversy And Supporting Evidence
Gabapentin is not without its controversies. After its initial approval, gabapentins manufacturer got in trouble for marketing it for a range of off-label purposes without enough supporting evidence. More recently, the opioid epidemic has motivated many doctors to prescribe gabapentin as an alternative painkiller, which has also been met with some criticism.1 There are reasons, therefore, to be skeptical of non-FDA approved uses of gabapentin.
However, some off-label uses of this drug are well-founded. FDA approvals of gabapentin for both shingles treatment and restless leg syndrome have happened more recently. And in the case of alcohol addiction, there is increasing evidence to support gabapentins effectiveness:
- One study in 2007 demonstrated that people who took gabapentin had more days of abstinenceand drank less alcohol on days when they did drinkthan those who took a placebo.2
- A 2011 study showed that gabapentin and naltrexone in combination had a bigger impact for people in the first 6 weeks of treatment than naltrexone alone.3
- Finally, a study in 2014 showed that 900-1800mg of gabapentin per day was two to four times as effective in maintaining abstinence compared with placebo, and nearly twice as effective for reducing heavy drinking.4
Alcohol Use Disorder Is Common And Serious
AUD affects about 14% of US adults and represents a significant health burden, often with severe clinical and social implications. It manifests as compulsive drinking and loss of control despite adverse consequences on various life domains. It is generally associated with cravings, tolerance, and withdrawal symptoms upon cessation. Alcohol withdrawal is characterized by tremors, anxiety, sweating, nausea, and tachycardia, and in severe cases, may involve hallucinations, seizures, and delirium tremens. Untreated, alcohol withdrawal can be fatal.
Even though psychosocial treatments for AUD by themselves are associated with high relapse rates, pharmacotherapy is underutilized. Three drugs approved by the US Food and Drug Administration are available to treat it, but they are often poorly accepted and have limited efficacy. For these reasons, there is considerable interest in finding alternatives. Gabapentin is one of several agents that have been studied . The topic has been reviewed in depth by Soyka and Müller.
Agents used to treat alcohol use disorder
What Is Gabapentin And Why Is It Prescribed
Gabapentin is one of those medications with a rising profile. An anticonvulsant, it is primarily prescribed to control or prevent seizures. Though not technically approved to treat nerve pain, adults recovering from a bout of shingles may also receive a prescription. This is known as off-label use. Mixing gabapentin and alcohol is not suggested.
In 2016, there were 64 million prescriptions dispensed, with estimates of off-label prescribing as high as 95%. It is the tenth most prescribed drug in the United States. The most common brand of gabapentin is Neurontin.
Other off-label uses of gabapentin may include prescriptions for the treatment of post-surgery nausea, vomiting, and pain, for instance. Additionally, it gained traction in the treatment of alcohol dependence and withdrawal, and for other substance use disorders.
However, some research suggests that gabapentins effectiveness for many of these off-label conditions is, at best, weak.
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How Is Gabapentin Used For Alcohol Addiction
Some research suggests that gabapentin may help reduce alcohol withdrawal symptoms and cravings. One small study found that gabapentin helped reduce anxiety and tremors in people who were detoxing from alcohol. Another study found that gabapentin reduced cravings for alcohol and improved abstinence rates in people with alcohol dependence.
Gabapentin may also help people who are trying to stay sober by reducing the pleasurable effects of drinking. In one study, people who took gabapentin before drinking reported feeling less intoxicated than those who did not take the medication.
Alcohol Use Disorder & Alcohol Withdrawal Syndrome
Alcohol is a powerful drug that changes your brain. It works on different pathways in your brain, including dopamine, serotonin, glutamate, and GABA pathways.â
When you drink a lot of alcohol over a long period of time and have alcohol use disorder, your brain can change so that you develop a tolerance to alcohol but also become dependent on it.â
You become unable to stop your impulse to drink, and if you stop drinking alcohol, you become sick with alcohol withdrawal syndrome.â
People who have alcohol use disorder might fully understand that alcohol is harming their health, but they canât stop the impulse to drink.â
During alcohol withdrawal, you have lowered GABA function in your nervous system, which causes an increase in your brain-stimulating, or excitatory, chemicals. Your stress response is also activated, which causes more cravings, worsened sleep, and worsened emotional states.â
Other symptoms of alcohol withdrawal include:
Alcohol withdrawal syndrome is classified in stages and you can move into more intense stages of withdrawal quickly without treatment. Some doctors use gabapentin and other medications to help treat alcohol withdrawal and alcohol use disorder.
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Can Gabapentin Help To Stop Drinking Or For Hangovers
According to researchers, Gabapentin can help alleviate alcohol withdrawal symptoms such as hangovers. A new study indicates that the nerve painkiller gabapentin may be beneficial in treating severe alcohol withdrawal symptoms and stopping you from drinking alcohol.Gabapentin can reduce alcohol withdrawal symptoms and works best after a few days of abstinence for people who have previously experienced more severe symptoms.
What Are The Effects Of Mixing Alcohol And Gabapentin
Gabapentin and Alcohol both act as depressants for the central nervous system . CNS depressants can cause the respiratory system to slow down, which results in an oxygen deficiency. When taken in combination the effects of both can be amplified.
Some of the most common side effects of gabapentin that can become amplified with alcohol are unsteadiness, drowsiness, and low energy/fatigue. Severe side effects and reactions can also become a concern when mixing alcohol and gabapentin. Serious side effects are more likely to occur in individuals with a history of respiratory problems.
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Alcohol Withdrawalincreases Excitatory Effects
Patients experiencing alcohol withdrawal have decreased GABA-ergic functioning and increased glutamatergic action throughout the central nervous system.,
Withdrawal can be subdivided into an acute phase and a protracted phase . During withdrawal, the brain activates its stress system, leading to overexpression of corticotropin-releasing factor in the amygdala. Protracted withdrawal dysregulates the prefrontal cortex, increasing cravings and worsening negative emotional states and sleep.
Symptoms Of Gabapentin Addiction
Because many people associate drug addiction with street drugs, they often have difficulty understanding that prescription drugs can also become addictive. While not all symptoms of an addiction to gabapentin happen to everyone, some are commonly experienced. These include:
- Difficulty with coordination
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Are All Types Of Alcohol Harmful With Gabapentin
Yes, all types of alcohol are harmful when taken with gabapentin. Due to the depressive nature of each drug, the side effects of alcohol and gabapentin become worse when combined. The mixture of alcohol and gabapentin increases the risk of amplified effects of each, such as impairment and the chance of life-threatening breathing problems.
Keep in mind that some types of alcohol can be more dangerous than others. This is because liquor has a higher alcohol percentage than beer and wine. The higher ABV makes it easier to get drunk faster, which increases the risk of harmful side effects.
While one beer or glass of wine might not be harmful when consumed with gabapentin, a few shots of liquor like whiskey can become dangerous.
What Happens If You Drink Alcohol While On Gabapentin
Gabapentin and alcohol each individually cause central nervous system depression and respiratory depression. Combining alcohol and gabapentin can worsen either or both effects.
CNS depressants slow brain activity and cause drowsiness and dizziness. Combining alcohol and gabapentin, two CNS depressants can worsen these effects, making you feel extra drowsy and dizzy, causing impairment and accidents. There is also an increased risk of seizures with excess alcohol use or alcohol withdrawal.
Respiratory depression occurs when youre not getting enough oxygen. Your breathing can become slowed and shallow or even stop. In 2019, the FDA warned that gabapentin could increase respiratory depression risk when combined with risk factors such as:
- Respiratory conditions such as COPD
- Use of medications or substance use that depress the CNS
Alcohol consumption and gabapentin can intensify this effect and increase the risk of overdose and death.
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Inpatient Trials Show No Benefitover Standard Treatments
Bonnet et al conducted a double-blind placebo-controlled trial in Germany in inpatients experiencing acute alcohol withdrawal to determine whether gabapentin might be an effective adjunct to clomethiazole, a GABAA modulator commonly used in Europe for alcohol withdrawal. Participants were randomized to receive placebo or gabapentin for 72 hours, with tapering over the next 3 days. All patients could receive rescue doses of clomethiazole, using a symptom-triggered protocol.
The study revealed no differences in the amount of clomethiazole administered between the 2 groups, suggesting that gabapentin had no adjunctive effect. Side effects were mild and comparable between groups.
Nichols et al conducted a retrospective cohort study in a South Carolina academic psychiatric hospital to assess the adjunctive effect of gabapentin on the as-needed use of benzodiazepines for alcohol withdrawal. The active group received gabapentin as well as a symptom-triggered alcohol withdrawal protocol of benzodiazepine. The control group received only the symptom-triggered alcohol withdrawal protocol without gabapentin.
No effect was found of gabapentin use for benzodiazepine treatment of alcohol withdrawal. It is notable that Bonnet et al and Nichols et al had similar findings despite their studies being conducted in different countries using distinct comparators and methods.
Can You Use Gabapentin For Alcohol Withdrawal
Yes, you can use gabapentin for alcohol withdrawal. Gabapentin has started to become a popular medication for alcohol withdrawal because of its seizure-treating properties.
Alcohol withdrawal begins as fast as 6 hours after the last ingestion of alcohol. The side effects of alcohol withdrawal include nausea, vomiting, and insomnia. Alcohol withdrawal can also lead to more severe side effects such as hallucinations, hypertension, tachycardia, and even seizures.
Currently, there is no evidence that gabapentin works more effectively than other drugs used to aid in alcohol withdrawal. For this reason, its not prescribed as much as Naltrexone, Antabuse, and other alcohol withdrawal medications.
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Does Gabapentin Affect The Taste Of Alcohol
There is no evidence to support that gabapentin affects the taste of Alcohol. However, based on the form of gabapentin taken there is the potential for a slight aftertaste.
That said, once the aftertaste is gone, gabapentin will no longer affect the taste of alcohol. Additionally, the liquid form of gabapentin is more likely to affect the taste of alcohol than the pill or capsule versions.
The Dangers Of Mixing Gabapentin And Alcohol
When taken as prescribed, gabapentin can help a person with medical issues and not become a problem. Still, for many, it can become addictive. When combined with alcohol abuse, this combination of addictions requires professional treatment for substance abuse. Treatment starts with detox for alcohol and gabapentin and can be continued in an outpatient program. If you need help letting go of these addictions, the time to reach out and get help is now.
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Is Gabapentin Used For Alcohol Addiction
Gabapentin is a medication that is most commonly used to treat seizures. It is also prescribed to treat nerve pain. Gabapentin is an analgesic and anticonvulsant medication. The way it works is not completely understood, but it is thought to work by binding to certain calcium channels in the brain and changing how nerve signals are sent. Gabapentin is similar to the neurotransmitter GABA.
Gabapentin is sometimes used as a treatment for alcohol addiction. Evidence suggests that gabapentin may help reduce cravings for alcohol and help prevent relapse. Gabapentin may also help reduce anxiety and help with sleep problems, both of which are common in people with alcohol addiction. If you are struggling with alcohol addiction, talk to your doctor about whether gabapentin may be a good option for you.
Gabapentin is a prescription medication that is most commonly used to treat seizure disorders. Gabapentin is also sometimes used to relieve the pain of nerve damage, particularly in people with shingles or diabetes. Some people use gabapentin to treat alcohol withdrawal symptoms, although there is limited evidence to support its effectiveness in this regard.
If you are struggling with alcohol addiction, you may be wondering if gabapentin can help. Heres what you need to know about how gabapentin is used for alcohol addiction and whether or not it is likely to be effective.
Does Gabapentin Work For Alcohol Addiction
The research on gabapentin for alcohol addiction is still fairly limited. However, the studies that have been conducted suggest that gabapentin may be a helpful tool for some people struggling with alcoholism. If you are considering using gabapentin for alcohol addiction, its important to talk to your doctor first to make sure its safe for you and to discuss whether its likely to be an effective treatment for you.
Gabapentin Abuse In People With Alcohol Use Disorder
Research shows that whilst some do mix gabapentin with alcohol the likelihood of alcoholics abusing gabapentin are low. People with opioid addictions are more likely to abuse gabapentin.
Gabapentin has been prescribed off-label for various other conditions such as:
- Neuropathic pain
- Restless leg syndrome
Doctors may prescribe off-label if they know that a drug is an effective treatment for conditions other than those initially intended.
Its perfectly legal for doctors to prescribe off-label. That said, pharmaceutical companies are not allowed to promote off-label prescriptions.
In 1996 Pfizer was found guilty of promoting off-label prescriptions of gabapentin to doctors in a 1996 lawsuit. Consequently, the company had to pay a hefty fine.
A 2012 study found that doctors tend to prescribe gabapentin off-label more than for its intended purpose.
Ten Toronto doctors interviewed in the study said they prescribed gabapentin off-label despite a lack of evidence-based research.
The doctors said they based their decision to prescribe gabapentin on what they have learned from peers and conferences.
The study concludes that the drug is effective in treating alcohol dependence. However, more scrutiny is needed to ensure patient safety.
Anticonvulsants And Alcoholism Connection
Gabapentin calms the brain by acting on GABA, precisely what a newly sober alcoholic needs to get out of their hyperactive state. It is thought this will reduce anxiety and improve sleep, which is linked to fewer alcohol cravings.
However, the brain is left in a hyper-aroused state characterized by anxiety, insomnia, agitation, and, in severe cases, seizures when the chronic alcohol use ceases and the brake is removed.
Even though it isnt precisely known what Gabapentin means for GABA, it is, for the most part, concurred that it either straightforwardly or by implication builds the accessibility of GABA in mind. To put it another way, it has some similarities to alcohol.
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What Are The Side Effects Of Gabapentin
Even if you dont drink alcohol, gabapentin can have adverse effects. You should consult your healthcare provider for medical advice about managing them. You could experience:
- Gastrointestinal effects: nausea, vomiting, constipation, diarrhea, dry mouth
- Nervous system effects: dizziness, sleepiness, fatigue, impaired coordination, tremor, involuntary eye movements
- Metabolic effects: swelling in the arms and legs, weight gain
Additionally, serious side effects associated with gabapentin include:
- Worsening depression
- Changes in mood or behavior
- Increased risk of suicidal thoughts or behavior
- Impaired driving
Gabapentin treatment should not be stopped abruptly because of the increased risk of seizures. Abrupt discontinuation of gabapentin can also cause anxiety, insomnia, nausea, pain, and sweating.
And remember, if you take gabapentin, avoid alcoholentirely. The combination of alcohol and gabapentin is dangerous. If you have any questions, consult your healthcare provider or pharmacist for guidance.
Risks Of Mixing Alcohol And Medications
According to the National Institute on Alcohol Abuse and Alcoholism , mixing alcohol and medications can be harmful for several reasons. There are two primary reasons healthcare providers warn patients of the risks of consuming alcohol and medicines like Gabapentin together. Those reasons include:
Additionally, research also suggests that the side effects of a medication can worsen with alcohol. Similarly, alcohol may cause new symptoms that are difficult to predict. This is especially true if the drug consumed causes drowsiness or sedation. The mixture of opiates and alcohol, for example, can cause your breathing to stop and is frequently attributed to overdose deaths that involve both substances.
Using alcohol along with medication can cause adverse health effects ranging from loss of consciousness, blood clots, seizures, and in extreme cases, even death. Risks usually depend on the type of medication used and, to some degree, the amount of alcohol consumed. Its important to note that any amount of alcohol can be detrimental.
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The Link Between Gabapentin And Alcohol
Gabapentin is federally approved to treat epilepsy and neuropathic pain, but research has discovered a surprising link between it and alcohol.
Gabapentin has become something of a wonder drug. It reduces seizures in people with epilepsy and treats nerve damage pain caused by shingles, phantom limb pain, carpal tunnel, and reflex sympathetic dystrophy. It also has a calming, relaxing effect similar to benzodiazepines.
The success of its ability to reduce convulsions and nerve-damage pain stems from its relaxing effect on the emotional part of the brain, the amygdala.
Interestingly, this relaxing effect has shown more health benefits than initially intended. Of particular note is its proven ability to treat alcohol use disorder.
The World Health Organization reports that 3 million die from alcohol-related harm each year. Although legal, alcohol is the third most significant global public health problem.
Gabapentin has the potential to reduce cravings for alcohol in heavy drinkers.
So why isnt it being prescribed more widely?
Gabapentin is an anticonvulsant.
It was created as a treatment for seizures in people with epilepsy.
Sold under the name Neurontin, gabapentin was created by Gerhard Satzinger PhD, Johannes H. Hartenstein PhD, and James R Zeller PhD in 1974 at Park Dawes laboratory in Germany. Park Dawes is a part of Warner-Lambert, itself a subsidiary of Pfizer.