The irreversible gamma-aminobutyrate transaminase inhibitor vigabatrin in the treatment of the alcohol withdrawal syndrome.

The pathophysiology of alcohol withdrawal is complex and still not fully understood in spite of intensive research. The variety of different theories accounts for the fact that at least 150 different drugs and drug combinations have been reported to be useful in the treatment of the alcohol withdrawal syndrome (AWS; Walinder and Svenson, 1989). Benzodiazepines are the most commonly used substance class in this context, with proven efficacy (Liskow and Goodwin, 1987) but also with serious abuse and dependence potential (Busto, 1986). The use of barbiturates, chloral hydrate or clormethiazole should be avoided, because of their toxicity and also high dependence risk. Other substances like tiapride, piracetam, nimodipine, bromocriptine, clonidine and /3-adrenoceptor-blocking agents also showed good results in clinical trials, but their actions cannot cover the complexity of symptoms in AWS(Rommelspacherefa/., 1991). In the early 1970s, research began to focus on anticonvulsant agents, such as carbamazepine or valproic acid. Carbamazepine especially proved to be a successful treatment strategy (Brune and Busch, 1971). Our group (Stuppaeck et al., 1991) conducted a double blind trial of carbamazepine vs oxazepam in AWS and showed equal efficacy of both substances. But, after a period of use of carbamazepine in AWS, we have also observed several cases of carbamazepine abuse (Stuppaeck etal., 1993).