Purpose: The purpose of this research project is to determine lorazepam-equivalent usage with a gabapentin taper compared to no gabapentin taper in the inpatient management of alcohol withdrawal syndrome.
Methods: This was a retrospective chart review that was approved by the Jefferson Health Institutional Review Board and conducted from January 1, 2024 to December 31, 2024. Patients were identified by initiation on the alcohol withdrawal scale (AWS) protocol. The study was divided into 2 groups: gabapentin and benzodiazepine or benzodiazepine-only. The primary endpoint was lorazepam-equivalent usage with a gabapentin taper compared to no gabapentin taper. Secondary outcomes included time from admission to AWS protocol initiation, time from AWS protocol initiation to gabapentin start, time to resolution of AWS symptoms, and length of stay in days from admission to discharge. A subgroup analysis of the primary endpoint was conducted among patients who received the appropriate gabapentin taper according to the AWS protocol.
Results: A total of 400 patients were screened for study inclusion, 70 patients met criteria for evaluation, and 35 patients were included in each group. The median lorazepam-equivalent usage (mg) during the withdrawal period was statistically significantly higher in the gabapentin and benzodiazepine group than in the benzodiazepine-only group (20 vs 3.10; p = 0.020). Among the 23 patients who received the appropriate gabapentin taper, the median lorazepam-equivalent usage (mg) was statistically significantly higher in the gabapentin and benzodiazepine group than in the benzodiazepine-only group (18 vs 3.10; p = 0.032). None of the secondary endpoints in the primary or subgroup analyses were statistically significant.
Conclusion: Benzodiazepine utilization in the management of alcohol withdrawal syndrome was not reduced by the addition of a gabapentin taper. Further research is needed to fully evaluate the benzodiazepine-sparing potential of gabapentin and to develop a standardized regimen for alcohol withdrawal management.
PGY1, Jefferson Health, Jefferson Abington Hospital
I am a current PGY1 pharmacy resident at Jefferson Abington Hospital. My future practice goal is to become an infectious diseases clinical pharmacist at an academic medical center.
