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American Journal of Health-System Pharmacy, Vol. 65, Issue 11, 1039-1047
Copyright © 2008. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00

Clinical Consultation

Treatment of alcohol withdrawal syndrome with carbamazepine, gabapentin, and nitrous oxide

 Valerie Prince and Kelly R. Turpin

VALERIE PRINCE, PHARM.D., BCPS, FAPHA, is Assistant Professor of Pharmacy Practice and KELLY R. TURPIN is a Pharm.D. degree candidate, McWhorter School of Pharmacy, Samford University, Birmingham, AL.

Address correspondence to Dr. Prince at McWhorter School of Pharmacy, Samford University, 800 Lakeshore Drive, Birmingham, AL 35229.


Purpose. To evaluate the potential use of carbamazepine, gabapentin, and nitrous oxide as alternatives to symptom-triggered benzodiazepine administration for the treatment of alcohol withdrawal syndrome (AWS), a literature review was conducted.

Summary. English-language reports of clinical trials of these agents in AWS, particularly trials that compared them with benzodiazepines or anticonvulsants or used them as benzodiazepine-sparing therapy, were reviewed. Six randomized, double-blind trials compared carbamazepine with agents used in the United States. The results suggest that carbamazepine may be useful for this indication, particularly in outpatient settings, although adverse effects and drug interactions may limit its usefulness. The role of gabapentin is unclear because of the lack of randomized, double-blind, controlled trials and the conflicting results of existing case series and open-label trials. Two poorly designed trials of nitrous oxide had conflicting results.

Conclusion. Because of the limitations in evidence accrued so far, the routine use of carbamazepine and gabapentin for the treatment of AWS cannot be recommended, and nitrous oxide should be avoided for this indication.

Index terms: Alcohols, ethyl; Anticonvulsants; Benzodiazepines; Carbamazepine; Drug interactions; Drug withdrawal; Gabapentin; Nitrous oxide; Toxicity

 





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