Alcohol Dependence
Conditions
Keywords
Alcoholism, Alcohol Dependence, Alcohol Withdrawal, Treatment, Pharmacotherapy
Brief summary
This is a placebo controlled trial (some people receive active and some people receive inactive medication) to evaluate the effectiveness of a new protocol to treat alcohol dependence. Two main medications (plus ancillary non-placebo controlled medications) and their placebos (inactive drugs) will be utilized to treat both alcohol withdrawal, promote abstinence, and reduce drinking over approximately a six-week treatment period. All participants will meet criteria for Alcohol Dependence and be drinking heavily up until 72 hours prior to receiving the first study drug. They will be injected one drug (flumazenil or placebo) over a two day period and receive the second one (gabapentin or placebo) by mouth for 39 days. The main hypothesis is that this protocol will reduce early alcohol withdrawal symptoms and will reduce relapse to drinking and promote abstinence compared to the placebo (inactive) drug group. Secondary outcomes that will be evaluated include reduction in craving, improvement in sleep, brain activity and mood.
Detailed description
Approximately 60 alcohol dependent individuals who are drinking heavily up until 72 hours, or less, prior to study participation will be randomized to receive either flumazenil (intravenously)on two successive days and gabapentin (orally)for 39 days or their matching placebos. They also will receive hydroxyzine and vitamins. Individuals will be evaluated for alcohol withdrawal, their response to acoustic startle, cognitive ability, craving, mood, sleep and drinking during the first week. They will then be seen weekly for about 6 weeks during which they take gabapentin or placebo and are provided with Combined Behavioral Intervention Therapy (counseling) once a week, or more, as required. Over this period they will be evaluated weekly for alcohol consumption, craving, sleep, mood, and biological markers of alcohol consumption ( percent carbohydrate deficient transferrin and gamma-glutamyl transferase). Blood will be obtained on week 3 and 6 for general health (liver, blood count etc.) screening. After the end of treatment, subjects will be followed-up at 4 weeks and again at 8 weeks after treatment to evaluate alcohol consumption, craving, sleep, mood. Subjects will undergo a functional magnetic resonance imaging (MRI) procedure sometime during the second or third week of study medication to assess cue induced regional brain activation to investigate the effect of medication on brain response to alcohol visual cues.
Interventions
DRUGFlumazenil and Gabapentin
2 mg flumazenil for infusion given slowly over 20 minutes given day 1 and day 2 gabapentin 300 mg increasing to 1200 mg over 4 days and continuing to day 30. Gabapentin 900 mg Day 31 to Day 33 gabapentin 600 mg Day 34 to 36 and gabapentin 300 mg Day 37 to 39.
DRUGPlacebo
20 mg Saline infused slowly over 20 minutes. Placebo 1 capsule Day 1, 2 capsules Day 2, 3 capsules Day 3, 4 capsules days 4 to 30; 3 capsules Day 31 to 33; 2 capsules day 34 to 36 and 1 capsule 37 to 39.
Sponsors
Medical University of South Carolina
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18 - 70. 2. Participants will meet criteria for primary DSM IV alcohol dependence, drink on at least 70% of days in the last 30 days prior to assessment, and drink at least 5 drinks per drinking day. 3. No more than 72 hours since last drink of alcohol. Rationale: to focus on symptoms occurring during the early alcohol cessation period. 4. Low CIWA-Ar group: have a CIWA-Ar score less than or equal to 6; High CIWA-Ar group: have a CIWA-Ar score greater than or equal to 7 but less than or equal to 15. 5. Able to read and understand questionnaires and informed consent. 6. Has stable housing for past 3 months.
Exclusion criteria
1. Currently meets DSM-IV criteria for any other psychoactive substance dependence disorder except nicotine dependence. 2. Any psychoactive substance abuse, except marijuana and nicotine, within the last 30 days as evidenced by subject report or urine drug screen. 3. Meets DSM-IV criteria for current axis I disorders of major depression, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress syndrome, bipolar affective disorder, schizophrenia, or any other psychotic disorder or organic mental disorder. The rationale for excluding them is that symptoms from these disorders may affect dependent variables and complicate interpretation of the data. 4. No use of benzodiazepines in excess of three times in the past two weeks by self report and urine drug screen. 5. Subjects must not be taking zolpidem (Ambien™), zaleplon (Sonata™), or eszopiclone (Lunesta™) in excess of three times in past two weeks. 6. No history of delirium tremens or alcohol withdrawal seizures. 7. Has current suicidal ideation with plan or homicidal ideation. 8. Need for maintenance or acute treatment with any psychoactive medication including antiseizure medications. 9. Use of disulfiram, naltrexone, acamprosate, or anticonvulsants in last 30 days. 10. Clinically significant medical problems such as cardiovascular, renal, GI, or endocrine problem that would impair participation or limit medication ingestion. 11. Sexually active females of child-bearing potential who are pregnant (by -beta HCG), nursing, or who are not using a reliable form of birth control. 12. Has current charges pending for a violent crime (not including DUI related offenses). 13. Has taken gabapentin or flumazenil in the last month or has experienced adverse effects from it at any time in the past. 14. Hepatocellular disease indicated by elevations of SGPT (ALT) and SGOT (AST) greater than 3 times normal at screening. 15. Persons with metal implants or pacemaker since fMRI will be used.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent Subjects Completely Abstinent | 6 week trial | percent of subjects completely abstinent during the six week medication study study |
| Percent Days Abstinent | Weeks 1 to 6 | percent days abstinent during treatment |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Low CIWAar Placebo | 18 |
| Low CIWAar Flumazenil/Gabapentin | 26 |
| High CIWAar Placebo | 9 |
| High CIWAar Flumazenil/Gabapentin | 7 |
| Total | 60 |
Baseline characteristics
| Characteristic | Low CIWAar Flumazenil/Gabapentin | High CIWAar Placebo | Low CIWAar Placebo | High CIWAar Flumazenil/Gabapentin | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 26 Participants | 9 Participants | 18 Participants | 7 Participants | 60 Participants |
| Age, Continuous | 44.1 years STANDARD_DEVIATION 11.9 | 50.3 years STANDARD_DEVIATION 8.5 | 47.2 years STANDARD_DEVIATION 11.2 | 46.7 years STANDARD_DEVIATION 5.6 | 46.1 years STANDARD_DEVIATION 10.6 |
| Region of Enrollment United States | 26 participants | 9 participants | 18 participants | 7 participants | 60 participants |
| Sex: Female, Male Female | 6 Participants | 3 Participants | 4 Participants | 1 Participants | 14 Participants |
| Sex: Female, Male Male | 20 Participants | 6 Participants | 14 Participants | 6 Participants | 46 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 18 | 0 / 26 | 0 / 9 | 0 / 7 |
| serious Total, serious adverse events | 0 / 18 | 0 / 26 | 0 / 9 | 0 / 7 |
Outcome results
Primary
Percent Days Abstinent
percent days abstinent during treatment
Time frame: Weeks 1 to 6
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Low CIWA Flumazenil/Gabapentin | Percent Days Abstinent | 70.8 percent days | Standard Deviation 24.2 |
| Low CIWAar Placebo | Percent Days Abstinent | 86.1 percent days | Standard Deviation 20.7 |
| High CIWAar Placebo | Percent Days Abstinent | 75.9 percent days | Standard Deviation 27 |
| High CIWAar Flumazenil/Gabapentin | Percent Days Abstinent | 95.9 percent days | Standard Deviation 9.7 |
Comparison: The analysis was an ANOVA interaction analysis with alcohol withdrawal (AW) group (Low vs. High) by medication group (active versus placebo medication) across the 6 weeks of the medication trial.p-value: 0.0006ANOVA
Primary
Percent Subjects Completely Abstinent
percent of subjects completely abstinent during the six week medication study study
Time frame: 6 week trial
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Low CIWA Flumazenil/Gabapentin | Percent Subjects Completely Abstinent | 44 percent of participants |
| Low CIWAar Placebo | Percent Subjects Completely Abstinent | 19 percent of participants |
| High CIWAar Placebo | Percent Subjects Completely Abstinent | 33 percent of participants |
| High CIWAar Flumazenil/Gabapentin | Percent Subjects Completely Abstinent | 71 percent of participants |
p-value: 0.03Regression, Logistic