Pregabalin, tiapride and lorazepam in alcohol withdrawal syndrome: a multi-centre, randomized, single-blind comparison trial.

Introduction The aim of this trial was to compare lorazepam with non-benzodiazepine medications such as pregabalin and tiapride in the treatment of alcohol withdrawal syndrome (AWS). These drugs were chosen for their inhibitorial\r\neffects on the hypersecretion of neurotransmitters usually observed in AWS. Craving reduction and improvement of\r\npsychiatric symptoms were the secondary end-points. Methods One hundred and ninety subjects affected by current\r\nalcohol dependence were considered consecutively: 111 were enrolled and divided into three groups of 37 subjects\r\neach. Within a treatment duration of 14 days, medication was given up to the following maximum doses (pregabalin\r\n450 mg/day; tiapride 800 mg/day; lorazepam 10 mg/day). Withdrawal (CIWA-Ar), craving [visual analogue scale\r\n(VAS); Obsessive and Compulsive Drinking Scale (OCDS)], psychiatric symptoms [Symptom Check List 90 Revised\r\n(SCL-90-R)] and quality of life (QL-index) rating scales were applied. Results On the CIWA-Ar score, all the groups\r\nshowed a significant reduction between times (P < 0.001) with a higher reduction for the pregabalin group (P < 0.01)\r\non items regarding headache and orientation. Retention in treatment was lower in the tiapride group (P < 0.05), while\r\nthe number of subjects remaining alcohol free was higher in the pregabalin group (P < 0.05). Significant reduction\r\nbetween baseline and the end of the treatment was found in all the groups at the OCDS and the VAS for craving, at the\r\nSCL-90-R and QL-index (P < 0.001). Discussion All the medications in the trial showed evidence of safety and\r\nefficacy in the treatment of uncomplicated forms of AWS, with some particular differences. The efficacy of pregabalin\r\nwas superior to that of tiapride, used largely in research trials and, for some measures, to that of the ‘gold standard’,\r\nlorazepam. Accordingly, pregabalin may be considered as a potentially useful new drug for treatment of AWS, deserving further investigation.