From Management to Maintenance: A Pilot Ambulatory Gabapentin Bridge Protocol for Treatment of Low-risk Alcohol Withdrawal Syndrome.

Abstract

Ambulatory management of mild to moderate alcohol withdrawal syndrome (AWS) remains underutilized despite evidence supporting its safety and effectiveness. We developed and tested a fixed-dose gabapentin taper protocol for AWS, designed to standardize patient selection, monitoring during treatment, and also allow for transition to maintenance pharmacotherapy for alcohol use disorder (AUD). Retrospective case series of the first 10 consecutive patients treated with a 6-day fixed-dose gabapentin taper (1800 mg tapered to 300 mg) at a hospital-based bridge clinic. Eligibility required low risk for complicated withdrawal per validated screening criteria. Follow-up included telemedicine visits on days 2-3 and in-person or virtual assessment at day 7 and 1 month. No patients experienced progression to complicated AWS, and none required emergency department visits or inpatient escalation. All patients either successfully completed the taper or opted to remain on a maintenance dose of gabapentin before the conclusion of the taper. Nine of 10 patients (90%) reported abstinence through day 7. At 1-month follow-up, 7 patients (70%) remained abstinent, 9 (90%) were retained in treatment, and all 10 (100%) had transitioned to medication for alcohol use disorder (MAUD) maintenance pharmacotherapy. A standardized gabapentin taper with telemedicine follow-up demonstrated early safety signals, high short-term abstinence, and successful transition to maintenance treatment for patients with AWS who were deemed low risk for progression to complicated withdrawal. Prospective, randomized trials comparing fixed-dose gabapentin tapers with symptom-triggered benzodiazepine or phenobarbital regimens are needed across diverse ambulatory settings to confirm these preliminary findings.