Gabapentin dependence and withdrawal requiring an 18-month taper in a patient with alcohol use disorder: a case report
| Autor: | Huiqiong Deng, Ori-Michael J. Benhamou, Anna Lembke |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Gabapentin 030508 substance abuse Medicine (miscellaneous) Alcohol Alcohol use disorder 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine mental disorders medicine Insomnia Humans 030212 general & internal medicine Drug Tapering business.industry General Medicine medicine.disease nervous system diseases Substance Withdrawal Syndrome Psychiatry and Mental health Clinical Psychology Alcoholism Peripheral neuropathy chemistry Anti-Anxiety Agents Seizure Disorders Anesthesia Neuralgia Female medicine.symptom 0305 other medical science business medicine.drug |
| Zdroj: | Journal of addictive diseases. 39(4) |
| ISSN: | 1545-0848 |
| Popis: | Gabapentin has been widely used to manage post-herpetic neuralgia, peripheral neuropathy, seizure disorders, alcohol use disorder (AUD), alcohol withdrawal, and insomnia. Although usually well tolerated, gabapentin has been reported to cause severe physiologic dependence and withdrawal. Tapering gabapentin in this context poses a significant clinical challenge, with little published information to date on meeting this challenge. This case highlights the need for patient-centered slow tapers in patients with severe gabapentin dependence and withdrawal. We present a 32-year-old female effectively treated for AUD with 1,200 mg daily dose of gabapentin, who developed gabapentin dependence and severe withdrawal. Recognizing her intolerance to gabapentin withdrawal after a brief accidental pause of medication, a taper plan was initiated using the framework of the BRAVO Protocol. On average, she reduced daily gabapentin dose by 100 mg per month until she reached 300 mg. The taper then slowed to 20-30 mg dose decrements per month. For the last 100 mg, she tapered down at 5 mg decrements every one to two weeks to 60 mg, at which point she discontinued gabapentin. The entire taper process took eighteen months. The BRAVO protocol outlines a safe and compassionate strategy. Originally developed for opioids and adapted to benzodiazepines, the use of the Bravo Protocol provides a framework for a gabapentin taper. For patients in whom gabapentin treatment leads to severe dependence and withdrawal, the BRAVO Protocol provides a practical, patient-centered framework for tapering. |
| Databáze: | OpenAIRE |
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