Gabapentin for Alcohol Detoxification
1. Baseline Revised CIWA Score
2. Repeat as indicated based on clinical response to gabapentin protocol below
1. Severe Renal Failure
2. Allergy to gabapentin
Please refer patients to the hospital for inpatient detoxification, who have a history of DTs or any 2 of the following 3 significant risk factors for complicated withdrawal: 1) Age >65; 2) Multiple co-morbid conditions including MI, HTN, CVA, AAA; 3) History of seizures.
1. Gabapentin 400 mg three times daily for 3 days
2. Then gabapentin 400 mg in the morning and at bedtime on day 4
3. Okay to use additional 300 mg dose of gabapentin x 1 on day 1 for breakthrough symptoms of withdrawal
4. Okay to use additional 100 mg dose of gabapentin x 1 on days 2 through 4 for breakthrough symptoms of withdrawal
5. Thaimine 100 mg daily for 12 days
6. Multivitamin daily
*Per Dr. Myrick, author of the VA Protocol for gabapentin detoxification and principle investigator of the DBRCT validating the efficacy of this intervention, clinicians can extend the gabapentin taper for an additional 7 to 21 days to treat subacute, protracted symptoms of withdrawal, such as insomnia, irritability, and anxiety.
Reference: Myrick H, Malcolm R, Randall PK, Boyle E, Anton RF, Becker HC, Randall CL: A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009 Sep;33(9):1582-8.
Other supporting data from Watson et al., 1997; Myrick et al., 1998; Voris et al., 2003; Mariani et al., 2006.