Clinical Guidance: Gabapentin Combined With Naltrexone for Treatment of Alcohol Dependence
Gabapentin and naltrexone have both been proposed as treatments to diminish relapse in recently abstinent patients with alcoholism. In a 16-week trial of naltrexone (50 mg/day), naltrexone combined with gabapentin (up to 1,200 mg/day) for the first 6 weeks, or double placebo, the combined treatment outperformed both naltrexone alone and placebo, but the effect did not persist beyond 6 weeks. The 6-week period was chosen because Anton et al. (CME, p. 709) believed that initial co-treatment with gabapentin would help by diminishing the insomnia and mood instability experienced by patients in their first 6 weeks of abstinence. O'Brien points out in an editorial (p. 670) that the combination is safe and that the study is a good example of the rigorous evaluation of a rational combination designed to address the range of symptoms and difficulties presented by patients with alcoholism who seek to maintain abstinence.