Gabapentin is a medication that has been used for seizures since the 1990s. It’s now being reconsidered and researched as a treatment for alcohol use disorder.
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.
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.
You become unable to stop your impulse to drink, and if you stop drinking alcohol, you become sick with alcohol withdrawal syndrome.
People who have alcohol use disorder might fully understand that alcohol is harming their health, but they can’t stop the impulse to drink.
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.
Other symptoms of alcohol withdrawal include:
- Sweating
- Shaky hands
- Nausea
- Throwing up
- Fast heart rate
- Anxiety
- Hallucinations
- Seizures
- Chills
- Disorientation
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.
What Is Gabapentin?
Gabapentin is a medication used for epilepsy seizures, restless leg syndrome, and nerve pain caused by shingles. While it has been used to treat other addictions, it’s usually used specifically for alcohol use disorder.
Scientists don’t fully understand how gabapentin works, but it influences your brain chemicals by blocking the release of brain-stimulating chemicals.
Some brain chemicals are stimulating or excitatory, which means they cause brain cells to fire. Too much stimulation in the brain can lead to seizures. Other brain chemicals are inhibitory and can block brain cells from firing. These have a calming effect on the nervous system.
When excitatory chemicals are blocked, the inhibitory chemicals like GABA can increase in the body, which helps calm the nervous system.
Gabapentin also raises serotonin levels in your blood, which is calming, though, it doesn’t interact with any serotonin or other brain chemical receptors.
In alcohol use disorder, there’s an imbalance between these stimulating and calming brain chemicals.
Gabapentin for Alcohol Withdrawal
Benzodiazepine medications are the standard treatment for alcohol use disorder and alcohol withdrawal. They help lower your risk for seizures and hallucinations, but they are highly addictive medications.
Some research shows that gabapentin has promise as an alcohol withdrawal treatment, possibly in combination with other medications.
Gabapentin can:
- Help stop the impulse to drink, especially in early abstinence treatment
- Reduce alcohol cravings
- Improve insomnia
- Lower anxiety
- Improve mood
- Prevent relapse
A clinical trial showed that people with alcohol use disorder were treated with gabapentin and there were more people with no heavy drinking days than those who were treated with the placebo.
But some studies also show that gabapentin had no benefit over other treatments and that using gabapentin with other treatments didn’t shorten treatment time. One researcher suggested that it might actually make treatment cost more without changing outcomes.
Other studies say that because gabapentin doesn’t stop seizures, it shouldn’t be used alone as a treatment for alcohol withdrawal.
There’s also some risk for gabapentin misuse, but clinical trials show that it's not a high risk specifically for alcohol use disorder. Other evidence shows that there is a risk for people who misuse opioids.
Who Should Use Gabapentin for Alcohol Use Disorder?
The research is mixed on gabapentin and more research is needed to understand how it can be used.
Studies suggest this medication should only be used for people who don’t respond to standard treatments and who don’t have a tendency to misuse opioid, illicit, or prescription drugs.
Based on the evidence, gabapentin is probably best used for:
- Relapse prevention
- Early abstinence treatment
- Mild alcohol withdrawal
- Lowering the number of heavy drinking days
It doesn’t work as well as benzodiazepines for withdrawal and probably won’t be as effective for severe withdrawal.
Your doctor will discuss the risks and benefits with you and decide if gabapentin is a good choice for your treatment.
Gabapentin Side Effects
Gabapentin can have side effects in some people. These include:
- Depression
- Allergic reactions
- Dizziness
- Headache
- Anxiety
- Trouble with memory
- Weight gain
- Dry mouth
- Weakness
- Sleepiness
- Swelling
- Diarrhea
- Constipation
- Heartburn
- Seizures
Suddenly stopping gabapentin medication can also cause withdrawal symptoms like nausea, pain, sweating, and throwing up. It’s important to take your medication exactly as your doctor directs to avoid any complications.
Gabapentin should only be used under the supervision of your doctor. Alcohol detoxification can be dangerous and finding the right dose for you is important. It’s best to have a supervised medical detox that can help you through your symptoms and stages of withdrawal.
