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Clinical Update

Inpatient Use of Benzodiazepines for Patients With Substance Use Disorders

January 31, 2024

Audrey Abelleira, PharmD, BCPP. Clinical pharmacist practitioner, VA Connecticut Healthcare System; clinical instructor, Yale School of Medicine, New Haven, CT.

Dr. Abelleira has no financial relationships with companies related to this material.

Benzodiazepines are highly beneficial for managing anxiety and agitation in psychiatric inpatient settings, but we must be cautious about prescribing them to patients with substance use disorders (SUDs). Here we review strategies to reduce the risk of benzodiazepine misuse and discuss alternative medication options, including second-generation antipsychotics, antidepressants, gabapentin, and pregabalin.

Clinical Update

Gabapentin: A Double-Edged Sword

April 1, 2023

Noah Capurso, MD and Shram Shukla, MD

Shram Shukla, MD. Addiction psychiatry fellow, Yale School of Medicine. New Haven, CT.

Noah Capurso, MD, MHS. Assistant professor of psychiatry, Yale University. New Haven, CT. Editor-in-chief of The Carlat Addiction Treatment Report.

Dr. Shukla and Dr. Capurso have no financial relationships with companies related to this material.

Gabapentin has become one of the most widely prescribed medications in America. At the same time, concerns have emerged about its association with opioid overdose deaths. In this article, we review the data behind gabapentin treatment: when it should be used, how to use it, and when it should be avoided.

An Off-Label Guide to Gabapentin

January 31, 2022

Rajesh R. Tampi, MD, MS, DFAPA. and Chris Aiken, MD.

Rajesh R. Tampi, MD, MS, DFAPA. Professor of Medicine, Case Western Reserve University. Chairman, Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, and Chief of Geriatric Psychiatry, Cleveland Clinic. Chris Aiken, MD. Editor-in-Chief of TCPR. Practicing psychiatrist, Winston-Salem, NC. The authors have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Off-label gabapentin (Neurontin) got a bad rep when it missed the mark in bipolar disorder, but there may be something worth salvaging in this drug. Here, we weigh its pros and cons for anxiety, substance use disorders, sleep, pain, and hot flashes, and compare it to its underutilized cousin, pregabalin (Lyrica).

Mood and Menopause

October 6, 2020

Ruta Nonacs, MD, PhD

Ruta Nonacs, MD, PhD
Ruta Nonacs practices psychiatry at Massachusetts General Hospital’s Perinatal and Reproductive Psychiatry Clinical Research Program. She has published original research on peripartum mood disorders and is the author of A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years (Simon & Schuster). Dr. Nonacs has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Ruta Nonacs names the antidepressants that work best for menopausal depression and when to move to hormonal therapies. And for adolescents and young adults, she tells us which birth control pills are least likely to worsen mood.

EXPERT Q&A

Gabapentin Misuse and Diversion

June 10, 2020

Rachel Vickers-Smith, PhD, MPH

Rachel Vickers-Smith, PhD, MPH
Assistant Professor at University of Louisville, KY. Dr. Vickers-Smith has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Clinicians are increasingly turning to gabapentinoids as non-opioid alternatives for pain treatment. Yet we may be inadvertently introducing new risks in so doing. Dr. Vickers-Smith reviews current epidemiology of gabapentinoid use and offers some clues regarding how to turn the tide on gabapentin misuse.

Gabapentin for Alcohol Use Disorder, Redux

June 10, 2020

Rehan Aziz, MD.

Rehan Aziz, MD. Dr Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Which patients with alcohol use disorder might benefit from gabapentin most? This randomized controlled trial focused on gabapentin’s impact on alcohol use among patients with alcohol use disorder and who had also had alcohol withdrawal symptoms in the past.

Safe Use of Gabapentin with Patients

June 19, 2019

Although there’s been a lot of discussion about gabapentin’s abuse potential, gabapentin substance use disorders are pretty rare, with one study finding that only 2% of 44,148 patients using gabapentin alone met criteria for sustained overuse (Peckham et al, Pharmacotherapy, in press). The one area where you should show caution,...