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Alcoholism and Viral Hepatitis

Nicole Cutler L.Ac. June 23, 2008

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Conquering viral hepatitis is hard enough without the added challenge of alcoholism. The drug gabapentin as a treatment for alcohol dependence is currently being evaluated in human trials.

Since drinking alcohol can rapidly accelerate the liver damage caused by chronic viral hepatitis, a diagnosis of Hepatitis B or C always demands immediate cessation of consuming anything with alcohol. For some individuals, abandoning an occasional drink is easy. However, those with an addiction to alcohol will likely find giving up booze to be the hardest part of being diagnosed with chronic liver disease. To put the task of abstinence within an alcoholic’s reach, researchers are currently looking into the use of gabapentin to help people overcome alcohol addiction.

What is Gabapentin?

Originally approved by the U.S. Food and Drug Administration in 1994, gabapentin was originally developed for the treatment of epilepsy. In a class of medications called anticonvulsants, gabapentin treats seizures by decreasing abnormal excitement in the brain. Also widely known by its brand name Neurontin, more recent applications include its ability to reduce several types of chronic pain.

Gabapentin is a structural analog of the neurotransmitter GABA (gamma-aminobutyric acid). Although GABA has anticonvulsant properties, gabapentin’s molecular and cellular mechanisms of action are unclear. Despite this uncertainty, scientists who investigate alcoholism know that the GABAergic system in the brain plays an important role in regulating voluntary ethanol intake.

Gabapentin for Alcohol Dependence

Scientists have known for several years that alcohol produces many of its intoxicating actions through GABA receptor activation. Pre-clinical studies of alcohol dependence have shown that GABAergic activity decreases during alcohol withdrawal and protracted abstinence – the periods in which a recovering alcoholic is vulnerable to relapse.

Researchers at Scripps Research Institute believe that these GABAergic changes are probably a major cause of relapse in individuals undergoing treatment for alcoholism. By activating GABA receptors, these published studies support the use of gabapentin to help overcome alcohol addiction:

  • A randomized, double-blind, placebo-controlled trial published in the November 2007 edition of Journal of Clinical Psychiatry evaluated the use of gabapentin in alcoholics being treated in a Brazilian public outpatient drug treatment center. The researchers found that gabapentin reduced alcohol consumption and craving, which they concluded might help patients maintain abstinence.
  • As published in the May 2008 edition of the Journal of Neuroscience, investigators evaluated the effect of gabapentin on ethanol dependence. Although this was not a human study, the researchers did find that gabapentin reversed the behavioral measures of alcohol dependence. Their conclusion suggests that this drug represents a potential medication for the treatment of alcoholism.

Can Gabapentin Hurt the Liver?

Especially important for people living with a chronic viral hepatitis infection, any medications taken must be evaluated in terms of their potential to injure the liver. Although gabapentin is not metabolized by the liver, only future studies will confirm its safety for people with chronic hepatitis.

According to Yale University School of Medicine lecturer Orly Avitzur, MD, MBA, gabapentin is a water-soluble amino acid, which is eliminated unchanged by the kidneys without any appreciable metabolism by the liver. However, she does cite several cases of gabapentin-related liver toxicity in the medical literature.

Gabapentin’s manufacturer Pfizer reports an incidence of less than one percent of abnormal liver function in clinical trials of patients taking gabapentin with epilepsy or postherpetic neuralgia – the two most common uses for the drug. However, Pfizer has also collected an undisclosed number of spontaneous reports of hepatic events in its post-marketing safety surveillance database.

Before gabapentin is confirmed safe for those with viral hepatitis, it must first be proven as an effective treatment for alcoholism. Sponsored by the National Institute on Alcohol Abuse and Alcoholism, a study at The Scripps Research Institute is currently recruiting participants to evaluate this possibility.

Due to alcohol’s acceleration of liver damage in those with viral hepatitis, getting help abandoning booze is critical for people with Hepatitis B or C. While not yet a feasible option, gabapentin’s potential to help transition from alcohol dependence into abstinence signifies hope for those dually afflicted with alcoholism and chronic hepatitis.

References:

Furieri, FA, et al., Gabapentin reduces alcohol consumption and craving: a randomized, double-blind, placebo-controlled trial, Journal of Clinical Psychiatry, November 2007.

http://en.wikipedia.org, Gabapentin, Wikimedia Foundation Inc., 2008.

Roberto M, et al., Cellular and behavioral interactions of gabapentin with alcohol dependence, Journal of Neuroscience, May 2008.

www.clinicaltrials.gov, Gabapentin Treatment of Alcohol Dependence, US National Library of Medicine, 2008.

www.epilepsy.com, How Does the Body Digest Gabapentin?, epilepsy.com, 2008.

www.medscape.com, Gabapentin and Hepatotoxicity, Orly Avitzur, MD, MBA, Medscape Neurology and Neurosurgery, 2008.

www.newsrx.com, Gabapentin does not alter effects of alcohol, NewsRx, 2008.

www.nlm.nih.gov, Gabapentin, US National Library of Medicine, 2008.

www.scripps.edu, Scientists Describe Dangerous Cocktail of Alcohol, Brain Peptides, and Neurotransmitters, Jason Socrates Bardi, The Scripps Research Institute, 2008.

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