From Management to Maintenance: A Pilot Ambulatory Gabapentin Bridge Protocol for Treatment of Low-risk Alcohol Withdrawal Syndrome

Objective: Ambulatory management of mild to moderate alcohol withdrawal syndrome (AWS) remains underutilized despite evidence supporting its safety and effectiveness. We developed and tested a fixed-dose gabapentin taper protocol for AWS, designed to standardize patient selection, monitoring during treatment, and also allow for transition to maintenance pharmacotherapy for alcohol use disorder (AUD). Methods: Retrospective case series of the first 10 consecutive patients treated with a 6-day fixed-dose gabapentin taper (1800 mg tapered to 300 mg) at a hospital-based bridge clinic. Eligibility required low risk for complicated withdrawal per validated screening criteria. Follow-up included telemedicine visits on days 2–3 and in-person or virtual assessment at day 7 and 1 month. Results: No patients experienced progression to complicated AWS, and none required emergency department visits or inpatient escalation. All patients either successfully completed the taper or opted to remain on a maintenance dose of gabapentin before the conclusion of the taper. Nine of 10 patients (90%) reported abstinence through day 7. At 1-month follow-up, 7 patients (70%) remained abstinent, 9 (90%) were retained in treatment, and all 10 (100%) had transitioned to medication for alcohol use disorder (MAUD) maintenance pharmacotherapy. Conclusions: A standardized gabapentin taper with telemedicine follow-up demonstrated early safety signals, high short-term abstinence, and successful transition to maintenance treatment for patients with AWS who were deemed low risk for progression to complicated withdrawal. Prospective, randomized trials comparing fixed-dose gabapentin tapers with symptom-triggered benzodiazepine or phenobarbital regimens are needed across diverse ambulatory settings to confirm these preliminary findings.