A review of the treatment of alcohol withdrawal syndrome using carbamazepine, gabapentin and nitrous oxide can be found in the American Journal of Health Systems Pharmacology’s June 2008 edition written by Prince and Turpin.
The conclusions of the review are:
- Carbamazepine: This may be a useful agent for the treatment of alcohol withdrawal, particularly in the outpatient setting. The authors noted that additional trials are needed, since the trials that were reviewed had a very small sample size and included patients that did not use illicit substances. Also, in the trials that were evaluated, the carbamazepine was compared to benzodiazepines given in a fixed dose schedule as opposed to a preferable symptom-triggered protocol. Carbamazepine is also limited by its adverse effects which include: vertigo, pruritus, nausea and vomiting. High dose carbamazepine was associated with rash, diplopia, syncope, and ataxia. Drug interactions are not uncommon with its use. If it is used in seven day protocols, one does not have to worry about the liver or hematologic adverse effects.
Conclusion of the authors: Routine use of carbamazepine for alcohol withdrawal syndrome should not be advocated until additional trials have compared it to symptom-triggered benzodiazepine therapy.
- Gabapentin: It is noted that gabapentin is similar in structure to the neurotransmitter GABA and it may help in its release. One trial found gabapentin not superior to placebo. It may be useful in mild withdrawal according to one study.
Conclusion of the authors: Routine use of gabapentin for alcohol withdrawal syndrome cannot be recommended until additional, well-designed, controlled clinical trials are run.
- Nitrous Oxide: The authors felt that the clinical trials using nitrous oxide have been generally poor. One study used benzodiazepines and nitrous oxide so that no difference in efficacy was shown. Also, nitrous oxide requires the use of appropriate delivery apparatus as it is a gas. Training and equipment are needed which makes its use in alcohol withdrawal very limited.
Conclusion of the authors: Nitrous oxide should not be used in the treatment of alcohol withdrawal because sound clinical trials are lacking and its administration requires additional training and specialized devices.