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Gabapentin ‘could help treat alcohol dependence’

Gabapentin could be used to treat people for alcohol dependence, US researchers have claimed.

Compared with placebo, they found gabapentin enabled more people with alcohol dependence to completely abstain or at least cut out heavy drinking.

The study - published in JAMA this month - also found the drug reduced symptoms associated with relapse such as craving, insomnia and dysphoria.

The researchers said gabapentin – which is thought to work by normalising neurotransmitter pathways related to emotion, reducing anxiety and stress-related withdrawal symptoms – appears to be at least as effective as other drugs approved for alcohol dependence in the UK, while having the added advantage of improving sleep and mood.

The double-blind, randomised trial included 150 men and women with current alcohol dependence, who received gabapentin at a dose of either 900 mg or 1800 mg daily, or placebo, for 12 weeks.

At the end of the study, people taking the highest dose of gabapentin had entirely abstained from alcohol in four times as many cases as in the placebo group (17% compared with 4%) and cut out heavy drinking twice as often (45% versus 23%).

The results mean eight people would need to be treated with gabapentin to result in one person being completely abstinent, and five to be treated to stop one person drinking heavily.

People on the lower gabapentin dose showed intermediate benefits, with 11% entirely abstaining from alcohol and 23% refraining from drinking heavily.

The team, from the Scripps Research Institute in California, also found dose-dependent effects with gabapentin on standard measures of mood, sleep and craving.

The researchers said more dependent drinkers could access treatment in primary care if gabapentin is used, as GPs are familiar with prescribing it. The drug, originally used to treat epilepsy, is now also widely used for fibromyalgia and neuropathic pain.

They concluded in JAMA: ‘Increased implementation of pharmacological treatment of alcohol dependence in primary care may be a major benefit of gabapentin as a treatment option of alcohol dependence.’

Lead author Professor Barbara Mason said gabapentin had at least as large an effect on drinking outcomes as the drugs disulfiram, naltrexone and acamprosate, currently approved for alcohol dependence in the USA – the same drugs recommended by NICE.

She added: ‘Plus it’s the only medication shown to improve sleep and mood in people who are quitting or reducing their drinking, and it’s already widely used in primary care – that’s an appealing combination.’

The Scottish Medicines Consortium recently approved another drug – nalmefene – purely for helping dependent drinkers cut down their drinking.