A Randomized Double-Blind Pilot Trial of Gabapentin Versus Placebo to Treat Alcohol Dependence and Comorbid Insomnia

• Published in: Alcoholism, clinical and experimental research Vol. 32; no. 8; pp. 1429 - 1438
• Main Authors: Brower, Kirk J., Myra Kim, Hyungjin, Strobbe, Stephen, Karam-Hage, Maher A., Consens, Flavia, Zucker, Robert A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2008; Lippincott Williams & Wilkins
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Alcohol Dependence; Alcohol Drinking - prevention & control; Alcoholism; Alcoholism - complications; Alcoholism - drug therapy; Alcoholism and acute alcohol poisoning; Amines - adverse effects; Amines - therapeutic use; Antimanic Agents - adverse effects; Antimanic Agents - therapeutic use; Biological and medical sciences; Cyclohexanecarboxylic Acids - adverse effects; Cyclohexanecarboxylic Acids - therapeutic use; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gabapentin; gamma-Aminobutyric Acid - adverse effects; gamma-Aminobutyric Acid - therapeutic use; Humans; Insomnia; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Patient Compliance; Pharmacotherapy; Pilot Projects; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Relapse; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - drug therapy; Toxicology; Treatment Outcome; Human; Nervous system diseases; Relapse; Gabapentin; Alcoholism; Sleep disorder; Pharmacotherapy; Anticonvulsant; Concomitant disease; Randomization; Analgesic; Treatment; Insomnia; Placebo; Double blind study; Clinical trial; Alcohol Dependence; Neurological disorder; Comparative study
• ISSN: 0145-6008; 1530-0277; 1530-0277
• DOI: 10.1111/j.1530-0277.2008.00706.x

Background:  Insomnia and other sleep disturbances are common, persistent, and associated with relapse in alcohol‐dependent patients. The purpose of this pilot study was to compare gabapentin versus placebo for the treatment of insomnia and prevention of relapse in alcohol‐dependent patients. Methods:  Twenty‐one subjects, including 10 women who met study criteria for alcohol dependence and insomnia and expressed a desire to abstain from alcohol, were recruited to the study. During a 1 to 2 week placebo lead‐in and screening phase, a complete medical history, physical exam, blood tests, urine drug test, and structured interviews were performed to determine eligibility and patterns of alcohol use and sleep. Insomnia due to intoxication or acute withdrawal, psychiatric or medical illness, medications, and other sleep disorders were ruled out. Subjects were then randomized to either placebo (n = 11) or gabapentin (n = 10) for 6 weeks and titrated over a 10‐day period to 1,500 mg or 5 pills at bedtime. After a 4‐day taper, subjects were reassessed 6 weeks after ending treatment. Results:  Gabapentin significantly delayed the onset to heavy drinking, an effect which persisted for 6 weeks after treatment ended. Insomnia improved in both treatment groups during the medication phase, but gabapentin had no differential effects on sleep as measured by either subjective report or polysomnography. Conclusion:  Because gabapentin is a short‐acting medication that was taken only at nighttime in this study, it may possibly exert a nocturnal effect that prevents relapse to heavy drinking by a physiological mechanism not measured in this pilot study.