SHARE @ Advocate Health - Midwest - Scientific Day: Evaluation of High-Dose Gabapentin Load and Taper Versus Lorazepam Symptom-Triggered Protocol for the Treatment of Alcohol Withdrawal Syndrome in Neurocritical Care Patients
 

Affiliations

Advocate Christ Medical Center

Abstract

Background/Significance:

According to the National Center for Drug Abuse Statistics, in 2023 at least 6.7% of people with alcohol use disorder will go on to develop alcohol withdrawal syndrome (AWS). Benzodiazepines, the mainstay rescue treatment for AWS, are associated with detrimental side effects such as decreased consciousness and respiratory depression. Gabapentin has been studied as an alternative agent to benzodiazepines.

Purpose:

This study evaluated the difference in lorazepam requirements in patients admitted to the neurocritical care unit (NCCU) who received high dose gabapentin load and taper compared to patients on lorazepam symptom-triggered protocol for or at risk for developing AWS.

Methods:

In this retrospective study, patient data was collected from 11/1/2020, through 8/31/2024, in NCCU patients treated for or suspected to develop AWS at Advocate Christ Medical Center (ACMC), Advocate Lutheran General Hospital (LGH), and Aurora St. Luke’s Medical Center (ASLMC). Inclusion criteria included patients over the age of 18 years old, documentation of treatment of AWS, documentation of receiving gabapentin load and taper at ACMC (1200mg enteral for 1 dose followed by 900mg every 8 hours for 2 days) and received at least one dose of lorazepam for symptom-triggered CIWA-Ar protocol at LGH and ASLMC. Patients were excluded if prior to admission medications included gabapentin, benzodiazepines, or phenobarbital as well as a past medical history of epilepsy, seizures not attributable to AWS and known gabapentin intolerance. The primary endpoint was the difference in lorazepam requirements (in milligrams). Secondary endpoints included length of stay, use of lorazepam and phenobarbital as rescue medication(s), and complications of AWS, such as intubation rate.

Results:

After applying inclusion and exclusion criteria there were a total of 57 patients, 24 patients in the gabapentin group and 33 patients in the lorazepam group. Patients in the gabapentin group required an average of 1.42mg of lorazepam compared to an average of 7mg of lorazepam in the lorazepam group (p=0.001). The rate of intubation was similar between both groups with no patients in the gabapentin group requiring intubation due to over sedation.

Conclusion:

High dose gabapentin load and taper significantly decreased the lorazepam requirements of neurocritical care patients who are at risk for developing alcohol withdrawal syndrome without increasing the rates of intubation due to over sedation.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

Full Text of Presentation

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Document Type

Poster


 

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May 21st, 11:41 AM May 21st, 1:15 PM

Evaluation of High-Dose Gabapentin Load and Taper Versus Lorazepam Symptom-Triggered Protocol for the Treatment of Alcohol Withdrawal Syndrome in Neurocritical Care Patients

Background/Significance:

According to the National Center for Drug Abuse Statistics, in 2023 at least 6.7% of people with alcohol use disorder will go on to develop alcohol withdrawal syndrome (AWS). Benzodiazepines, the mainstay rescue treatment for AWS, are associated with detrimental side effects such as decreased consciousness and respiratory depression. Gabapentin has been studied as an alternative agent to benzodiazepines.

Purpose:

This study evaluated the difference in lorazepam requirements in patients admitted to the neurocritical care unit (NCCU) who received high dose gabapentin load and taper compared to patients on lorazepam symptom-triggered protocol for or at risk for developing AWS.

Methods:

In this retrospective study, patient data was collected from 11/1/2020, through 8/31/2024, in NCCU patients treated for or suspected to develop AWS at Advocate Christ Medical Center (ACMC), Advocate Lutheran General Hospital (LGH), and Aurora St. Luke’s Medical Center (ASLMC). Inclusion criteria included patients over the age of 18 years old, documentation of treatment of AWS, documentation of receiving gabapentin load and taper at ACMC (1200mg enteral for 1 dose followed by 900mg every 8 hours for 2 days) and received at least one dose of lorazepam for symptom-triggered CIWA-Ar protocol at LGH and ASLMC. Patients were excluded if prior to admission medications included gabapentin, benzodiazepines, or phenobarbital as well as a past medical history of epilepsy, seizures not attributable to AWS and known gabapentin intolerance. The primary endpoint was the difference in lorazepam requirements (in milligrams). Secondary endpoints included length of stay, use of lorazepam and phenobarbital as rescue medication(s), and complications of AWS, such as intubation rate.

Results:

After applying inclusion and exclusion criteria there were a total of 57 patients, 24 patients in the gabapentin group and 33 patients in the lorazepam group. Patients in the gabapentin group required an average of 1.42mg of lorazepam compared to an average of 7mg of lorazepam in the lorazepam group (p=0.001). The rate of intubation was similar between both groups with no patients in the gabapentin group requiring intubation due to over sedation.

Conclusion:

High dose gabapentin load and taper significantly decreased the lorazepam requirements of neurocritical care patients who are at risk for developing alcohol withdrawal syndrome without increasing the rates of intubation due to over sedation.

 

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