Creditability and Appropriateness of Lorazepam and Gabapentin Essay

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Creditability and Appropriateness of Lorazepam and Gabapentin Studies for the Detoxification of the Alcohol-Dependent Patient

Although benzodiazepines such as lorazepam remain the intervention of choice for the treatment of alcohol withdrawal symptoms based on a growing body of evidence that confirms their efficacy and relative safety, there are some significant risks that are associated with the use of lorazepam for alcohol detoxification, including potential benzodiazepine-alcohol interactions as well as the psychomotor and cognitive impairments that can result. Furthermore, the potential for cross-tolerance with alcohol may restrict the efficacy of benzodiazepines such as lorazepam in treating withdrawal symptoms. Therefore, identifying the optimal intervention or mix of interventions represents a timely and important enterprise. To this end, this paper provides an analysis of two peer-reviewed studies concerning the use of lorazepam and gabapentin for the treatment of alcohol withdrawal. The first study, "Safer use of benzodiazepines for alcohol detoxification: To avoid excessive dosing, be alert for falsely elevated CIWA-Ar scores" by Spiegel, Kumari and Petri (2012) concerns lorazepam and the second study, "Alcohol Withdrawal: When to Choose an Adjunctive Anticonvulsant," by Spiegel and Radac (2010) evaluates the appropriateness of gabapentin for alcohol withdrawal interventions. Finally, a summary of the research and important findings from these two studies are provided in the conclusion.

Review and Analysis

Study No. 1: Spiegel, D. R, Kumari, N. & Petri, J.D. (2012, October). Safer use of benzodiazepines for alcohol detoxification: To avoid excessive dosing, be alert for falsely elevated CIWA-Ar scores.

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Current Psychiatry, 11(10), 10-19.

The symptoms that are typically associated with alcohol withdrawal are primarily caused by the adverse effects of long-term alcohol exposure on brain gamma-aminobutyric acid (GABA) and glutamate systems and benzodiazepines such as lorazepam are the current standard of care. The research to date indicates that the use of lorazepam has been shown to be effective in limiting or even preventing morbidity and mortality in patients who are at risk of or are experiencing alcohol withdrawal (Spiegel, Kumari & Petri, 2012). These authors, though, also caution that falsely elevated scores can result from the administration of one of the screening instruments that is commonly used by clinicians for assessment of alcohol withdrawal systems, the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) (Spiegel et al., 2012). For instance, according to Spiegel et al., "The qualitative description of certain alcohol withdrawal symptoms is prone to subjective misinterpretation and can result, excessive benzodiazepine administration, and associated sequelae" (p. 12).

In sum, when used with the CIWA-Ar and other alcohol-withdrawal interventions such as nutrition and supportive care, lorazepam is an effective treatment for alcohol-withdrawal symptoms. As Spiegel et al. emphasize, though, "Although most patients with alcohol withdrawal respond to standard treatment that includes benzodiazepines, optimal nutrition, and good supportive care, a subgroup may resist therapy (resistant alcohol withdrawal)" (p. 17).

Study No. 2: Spiegel, D.R. & Radac, D. (2010, April). Alcohol withdrawal: When to choose an adjunctive.....

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