Karapetyan Kristina, Rosenfeldt Zachary, Caniff Kaylee
Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois.
Fed Pract. 2023 Apr;40(4):128-133. doi: 10.12788/fp.0362. Epub 2023 Apr 20.
Benzodiazepines are considered the gold standard for treatment of alcohol withdrawal syndrome (AWS), a group of symptoms that occur after abrupt cessation of alcohol use, but may be associated with serious adverse effects. Given the safety concerns, alternative treatment options for AWS management have been investigated, including gabapentin and baclofen. Because no available studies have investigated the inpatient use of the gabapentin and baclofen combination for alcohol detoxification, this study aims to evaluate their efficacy and safety in the inpatient hospital setting.
This retrospective cohort study at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois, included patients who were aged ≥ 18 years and who were admitted to the general acute medicine floor for the primary indication of AWS from January 1, 2014, to July 31, 2021. The primary outcome was the length of stay, defined as hours from admission to either discharge or 36 hours with a Clinical Institute Withdrawal Assessment of Alcohol (CIWA) score ≤ 8. Electronic health records were reviewed to collect CIWA scores, alcohol withdrawal seizure and delirium tremens incidence, rates of conversions from gabapentin/baclofen to lorazepam, rates of transitions to a higher level of care, and readmission for AWS within 30 days.
Mean length of stay in the gabapentin/baclofen group was statistically significantly shorter compared with the benzodiazepine group (42.6 vs 82.5 hours, < .001). The study found no significant difference between the gabapentin/baclofen and benzodiazepine groups in AWS readmission, adjuvant medications for AWS management, and number of patients who transitioned to a higher level of care. Overall, the safety of gabapentin/baclofen vs benzodiazepine were comparable; however, 1 patient experienced a seizure, and 1 patient experienced delirium tremens during admission in the benzodiazepine group.
Gabapentin/baclofen combination seems to be an effective and safe alternative to benzodiazepines and may be considered for managing mild AWS in hospitalized patients, but additional research is needed to examine this regimen.
苯二氮䓬类药物被认为是治疗酒精戒断综合征（AWS）的金标准，AWS是一组在突然停止饮酒后出现的症状，但可能伴有严重不良反应。鉴于安全问题，人们对AWS管理的替代治疗方案进行了研究，包括加巴喷丁和巴氯芬。由于尚无研究调查加巴喷丁和巴氯芬联合用于住院酒精解毒的情况，本研究旨在评估它们在住院环境中的疗效和安全性。
这项在伊利诺伊州北芝加哥詹姆斯·A·洛弗尔联邦医疗中心进行的回顾性队列研究，纳入了年龄≥18岁、于2014年1月1日至2021年7月31日因AWS主要指征入住普通急性内科病房的患者。主要结局是住院时间，定义为从入院到出院或临床研究所酒精戒断评估（CIWA）评分≤8持续36小时的时长。通过查阅电子健康记录来收集CIWA评分、酒精戒断性癫痫和震颤谵妄的发生率、从加巴喷丁/巴氯芬转换为劳拉西泮的比率、转至更高护理级别的比率以及30天内AWS再入院情况。
加巴喷丁/巴氯芬组的平均住院时间与苯二氮䓬类药物组相比在统计学上显著更短（42.6小时对82.5小时，<0.001）。研究发现，加巴喷丁/巴氯芬组和苯二氮䓬类药物组在AWS再入院、AWS管理辅助药物以及转至更高护理级别的患者数量方面无显著差异。总体而言，加巴喷丁/巴氯芬与苯二氮䓬类药物的安全性相当；然而，苯二氮䓬类药物组有1例患者在住院期间发生癫痫，1例患者发生震颤谵妄。
加巴喷丁/巴氯芬联合用药似乎是苯二氮䓬类药物的有效且安全的替代方案，可考虑用于管理住院患者的轻度AWS，但需要更多研究来检验该方案。
