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CNS Drugs

, Volume 29, Issue 4, pp 293–311 | Cite as

Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders

  • Christopher J. Hammond
  • Mark J. Niciu
  • Shannon Drew
  • Albert J. AriasEmail author
Review Article

Abstract

Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin’s ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

Keywords

Gabapentin Topiramate Naltrexone Pregabalin Levetiracetam 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

Funding source: Dr. Niciu receives salary support from the Intramural Research Program at the National Institutes of Health/National Institute of Mental Health (IRP-NIMH-NIH).

Conflict of interest and financial disclosures

Dr. Hammond, Dr. Niciu, Dr. Drew, and Dr. Arias report no conflicts of interest with respect to the content of this manuscript. Dr. Hammond has received support from the American Psychiatric Association Child and Adolescent Fellowship, an unrestricted education grant supported by Shire Pharmaceuticals and the American Academy of Child and Adolescent Psychiatry Pilot Research Award for Junior Investigators supported by Lilly USA, LLC. Dr. Arias has no financial disclosures. He holds (jointly through Yale University School of Medicine) a provisional use-patent on the medication perampanel for use in treating addictive disorders. Dr. Niciu has no financial disclosures to report. Dr. Drew reports no financial disclosures.

Contributor’s statements

All authors have participated in the concept and design, analysis and interpretation of data, and drafting or revising of this manuscript.

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Christopher J. Hammond
    • 1
    • 2
  • Mark J. Niciu
    • 3
  • Shannon Drew
    • 4
  • Albert J. Arias
    • 2
    • 4
    Email author
  1. 1.Yale Child Study CenterYale University School of MedicineNew HavenUSA
  2. 2.Department of PsychiatryYale University School of MedicineNew HavenUSA
  3. 3.Experimental Therapeutics and Pathophysiology BranchNational Institute of Mental HealthBethesdaUSA
  4. 4.Veterans Affairs Connecticut Healthcare System-West Haven CampusWest HavenUSA

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