Withdrawal symptoms after gabapentin discontinuation.

PURPOSE: A case of apparent gabapentin withdrawal symptoms after discontinuation of gabapentin therapy is reported.
SUMMARY: A 53-year-old woman had coffee ground emesis, a two-day history of black tarry stools, and abdominal pain. The patient did have an elevated ethanol concentration (323 mg/dL), with the last reported ingestion of ethanol about 12 hours before admission. Her medical history included liver cirrhosis secondary to ethanol abuse, ascites, portal hypertension, esophageal varices (with previous band ligation three weeks prior), anemia, gastroesophageal reflux disease, neuropathic pain, and depression. Her home medications included spironolactone, nadolol, lactulose, ursodiol, ferrous sulfate, omeprazole, gabapentin, citalopram, and trazodone. She was admitted to the intensive care unit, and upper gastrointestinal endoscopy was performed, with 12 band ligations applied. After the procedure, she ingested nothing orally, including home medications, for the first two days. On day 3 of hospitalization, she developed restlessness, disorientation, confusion, agitation, and anxiety. She was presumed to be suffering from ethanol withdrawal and was treated with benzodiazepines but had no improvement in symptoms. During days 4 and 5, the patient became increasingly confused, agitated, and anxious, with complaints of headache, light sensitivity, and increasing nervousness. On day 5, gabapentin was reinitiated, and the patient's confusion and agitation improved that evening. The next morning, the patient was calm, alert, and cooperative. Her symptoms resolved, and she was discharged on hospital day 7.
CONCLUSION: A patient developed apparent withdrawal symptoms beginning two days after gabapentin therapy was discontinued. The symptoms were unresponsive to treatment with benzodiazepines but completely resolved with the reinitiation of gabapentin therapy.