Comparing Gabapentin High Load Dose and Taper to Lorazepam for Management of Alcohol Withdrawal

Introduction: Benzodiazepines, the mainstay rescue treatment for AWS, are associated with detrimental side effects such as decreased consciousness and respiratory depression. 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, Advocate Lutheran General Hospital, and Aurora St. Luke’s Medical Center. Inclusion criteria included patients over the age of 18 years old, documentation of treatment of AWS, documentation of receiving gabapentin load and taper at Christ Medical Center (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 Lutheran and St. Luke's. 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). Rate of intubation was similar between both groups with the most common indication being airway protection (p=0.5034) and for a procedure (p=1). No patients in the gabapentin group required intubation due to over sedation.


Conclusions: 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.