Psychiatry Residency Training Program, Dept. of Psychiatry, John Peter Smith Hospital, Fort Worth, USA.
Research & Education, Behavioral Health Service, John Peter Smith Hospital, Fort Worth, USA.
Am J Drug Alcohol Abuse. 2020;46(1):49-57. doi: 10.1080/00952990.2019.1634085. Epub 2019 Sep 6.
: Lorazepam use in the treatment of alcohol withdrawal syndrome (AWS) is not without risk.: This study compares AWS outcomes using a standard, symptom-triggered lorazepam dosing protocol (control group) and symptom-triggered lorazepam dosing augmented with a gabapentin loading dose and taper (GABA group).: Consecutive, non-randomized adults (n = 982; 64.0% male) undergoing treatment for AWS were included in this retrospective, open-label study. Symptom-triggered lorazepam dosing was informed by scores on the Clinical Institute Withdrawal Assessment-Alcohol, revised (CIWA-Ar). Gabapentin augmentation utilized an initial loading dose (900 mg) and a three-day taper. Outcomes included average symptom severity per treatment hour and average lorazepam dose per treatment hour. Average time in the protocol by group, stratified by highest CIWA-Ar score, was examined as a secondary outcome. A priori group differences were controlled statistically.: GABA patients were older and exhibited somewhat more severe withdrawal symptoms than controls. After controlling for confounders, gabapentin augmentation did not significantly lower average lorazepam dosing per treatment hour or withdrawal symptom severity per treatment hour. Compared to controls, overall withdrawal symptoms diminished somewhat more rapidly for GABA patients experiencing low or moderate-level withdrawal symptoms; however, severe withdrawal symptoms remitted more slowly in the GABA group. Results should be interpreted in light of the uncontrolled nature of group assignment and other confounders.: Compared to symptom-triggered lorazepam dosing alone, gabapentin augmentation did not produce better outcomes during treatment of acute AWS. These results do not support the use of scheduled gabapentin as an augmentation to benzodiazepines during inpatient treatment of AWS.
：在治疗酒精戒断综合征（AWS）时使用劳拉西泮并非没有风险。：本研究比较了使用标准、症状触发的劳拉西泮剂量方案（对照组）和症状触发的劳拉西泮剂量方案加用加巴喷丁负荷剂量和减量（GABA 组）治疗 AWS 的结果。：连续、非随机的成年人（n = 982；64.0%为男性）接受 AWS 治疗，包括在这项回顾性、开放标签研究中。症状触发的劳拉西泮剂量由酒精修订后的临床研究所戒断评估量表（CIWA-Ar）评分决定。加巴喷丁的增加使用初始负荷剂量（900mg）和三天的减量。结果包括每治疗小时的平均症状严重程度和每治疗小时的平均劳拉西泮剂量。按组和最高 CIWA-Ar 评分分层检查平均方案时间，作为次要结果。：GABA 患者年龄较大，戒断症状稍严重。在控制混杂因素后，加巴喷丁的增加并没有显著降低每治疗小时的平均劳拉西泮剂量或每治疗小时的戒断症状严重程度。与对照组相比，低或中度戒断症状的 GABA 患者的整体戒断症状缓解速度稍快；然而，GABA 组的严重戒断症状缓解速度较慢。结果应结合组分配的非控制性和其他混杂因素来解释。：与单独使用症状触发的劳拉西泮相比，加巴喷丁的增加并没有在治疗急性 AWS 时产生更好的结果。这些结果不支持在 AWS 的住院治疗中，将加巴喷丁作为苯二氮䓬类药物的辅助药物使用。
