BETHESDA, MD — Gabapentin and pregabalin potentially could be useful for treating alcohol-use disorder (AUD), according to a recent study, but their comparative effectiveness in reducing alcohol consumption in real-world settings is unclear.
The Uniformed Services University of the Health Sciences-led study included participation from the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., also in Bethesda, MD, as well as the VA Northern California Healthcare System in Sacramento; the Crescenz VAMC in Philadelphia and the VA Connecticut Healthcare System in West Haven.
The researchers compared changes in alcohol consumption associated with gabapentin or pregabalin treatment with those of matched unexposed comparators. Their findings were published in medRxiv as preprint that had not yet been peer-reviewed by a journal.1
The study team identified patients who were prescribed gabapentin or pregabalin for 60 days or more for any indication between Jan. 1, 2009, and June 30, 2022, using electronic health records from the Veterans Aging Cohort Study (VACS-National). Alcohol consumption was measured using routinely collected Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaires.
Over, 592,957 gabapentin initiators, 14,923 pregabalin initiators and 2,959,006 eligible unexposed comparators who were eligible for matching were identified.
Results indicated that, compared to unexposed individuals, patients who received gabapentin (DiD: 0.09, 95% CI 0.06, 0.11, p<0.0001) or pregabalin (DiD: 0.14, 95% CI 0.02, 0.26, p=0.0279) reported greater reductions in AUDIT-C scores. When compared head to head, pregabalin initiators reported greater reductions in AUDIT-C scores than gabapentin initiators. The largest differences were observed among those with AUD (DiD: 0.86, 95% CI 1.22, 0.50, p<0.0001) and those who report baseline hazardous/binge drinking (DiD: 1.74, 95% CI 2.21, 1.27, p<0.0001).
“In this large, nationwide cohort, treatment with gabapentin and pregabalin were associated with reductions in reported alcohol consumption, compared to matched unexposed comparators,” the authors advised. “Initiation of pregabalin was associated with greater reductions than with gabapentin, particularly among those with AUD and those with highest severity of alcohol use. Known safety concerns and risk of misuse should be considered when prescribing these medications. Randomized clinical trials directly comparing these medications are necessary to validate these findings.”
- Gunawan T, Gray JC, Shi M, Wingo T, Wingo AP, Fiellin DA, Tazare J, Farokhnia M, Leggio L, Kranzler HR, Rentsch CT. Comparative effectiveness of gabapentin and pregabalin on reduction in alcohol use: A nationwide observational cohort study. medRxiv [Preprint]. 2026 Jan 15:2026.01.13.26344031. doi: 10.64898/2026.01.13.26344031. PMID: 41646699; PMCID: PMC12870570.