Anticonvulsivantes
A American Society of Addiction Medicine recomenda o uso de gabapentina, carbamazepina ou ácido valproico como tratamento adjuvante em populações de pacientes selecionadas com síndrome da abstinência alcoólica (SAA) leve.[5]American Society of Addiction Medicine. The ASAM clinical practice guideline on alcohol withdrawal management. J Addict Med. 2020 May/Jun;14(3s suppl 1):1-72.
https://www.doi.org/10.1097/ADM.0000000000000668
http://www.ncbi.nlm.nih.gov/pubmed/32511109?tool=bestpractice.com
No entanto, devido à falta de dados de alta qualidade de ensaios clínicos, gabapentina, carbamazepina e ácido valproico não são usados rotineiramente na prática para o tratamento da SAA.[106]Prince V, Turpin KR. Treatment of alcohol withdrawal syndrome with carbamazepine, gabapentin, and nitrous oxide. Am J Health Syst Pharm. 2008 Jun 1;65(11):1039-47.
http://www.ncbi.nlm.nih.gov/pubmed/18499876?tool=bestpractice.com
[107]Andaluz A, DeMoss D, Claassen C, et al. Fixed-dose gabapentin augmentation in the treatment of alcohol withdrawal syndrome: a retrospective, open-label study. Am J Drug Alcohol Abuse. 2020;46(1):49-57.
http://www.ncbi.nlm.nih.gov/pubmed/31490712?tool=bestpractice.com
Embora sejam limitadas, as evidências disponíveis sugerem que uma alta dose de gabapentina oral pode ser eficaz para limitar os sintomas de abstinência em pacientes com SAA leve versus placebo, reduzindo a necessidade de benzodiazepínicos, e pode ser tão eficaz quanto lorazepam para o tratamento da SAA.[108]Anton RF, Latham P, Voronin K, et al. Efficacy of gabapentin for the treatment of alcohol use disorder in patients with alcohol withdrawal symptoms: a randomized clinical trial. JAMA Intern Med. 2020 May 1;180(5):728-36.
https://www.doi.org/10.1001/jamainternmed.2020.0249
http://www.ncbi.nlm.nih.gov/pubmed/32150232?tool=bestpractice.com
[109]Levine AR, Carrasquillo L, Mueller J, et al. High-dose gabapentin for the treatment of severe alcohol withdrawal syndrome: a retrospective cohort analysis. Pharmacotherapy. 2019 Sep;39(9):881-8.
http://www.ncbi.nlm.nih.gov/pubmed/31278761?tool=bestpractice.com
[110]Myrick H, Malcolm R, Randall PK, et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009 Sep;33(9):1582-8.
http://www.ncbi.nlm.nih.gov/pubmed/19485969?tool=bestpractice.com
As evidências para carbamazepina e ácido valproico são ainda mais limitadas que as de gabapentina.[106]Prince V, Turpin KR. Treatment of alcohol withdrawal syndrome with carbamazepine, gabapentin, and nitrous oxide. Am J Health Syst Pharm. 2008 Jun 1;65(11):1039-47.
http://www.ncbi.nlm.nih.gov/pubmed/18499876?tool=bestpractice.com
[111]Barrons R, Roberts N. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. J Clin Pharm Ther. 2010 Apr;35(2):153-67.
https://www.doi.org/10.1111/j.1365-2710.2009.01098.x
http://www.ncbi.nlm.nih.gov/pubmed/20456734?tool=bestpractice.com
Cetamina
Dados sugerem que a cetamina pode reduzir a necessidade de benzodiazepínico durante o tratamento da abstinência alcoólica.[89]Long D, Long B, Koyfman A. The emergency medicine management of severe alcohol withdrawal. Am J Emerg Med. 2017 Jul;35(7):1005-11.
http://www.ncbi.nlm.nih.gov/pubmed/28188055?tool=bestpractice.com
Mais pesquisas se fazem necessárias.
Baclofeno
O uso de baclofeno na abstinência alcoólica está sendo estudado, mas, atualmente, não há evidências suficientes para dar suporte seu uso no contexto clínico.[5]American Society of Addiction Medicine. The ASAM clinical practice guideline on alcohol withdrawal management. J Addict Med. 2020 May/Jun;14(3s suppl 1):1-72.
https://www.doi.org/10.1097/ADM.0000000000000668
http://www.ncbi.nlm.nih.gov/pubmed/32511109?tool=bestpractice.com
[112]Liu J, Wang LN. Baclofen for alcohol withdrawal. Cochrane Database Syst Rev. 2019 Nov 6;2019(11):CD008502.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008502.pub6/full
http://www.ncbi.nlm.nih.gov/pubmed/31689723?tool=bestpractice.com