Frontiers in Psychiatry (Jan 2019)
The Use of Baclofen as a Treatment for Alcohol Use Disorder: A Clinical Practice Perspective
- Renaud de Beaurepaire,
- Julia M. A. Sinclair,
- Mathis Heydtmann,
- Giovanni Addolorato,
- Giovanni Addolorato,
- Henri-Jean Aubin,
- Henri-Jean Aubin,
- Henri-Jean Aubin,
- Henri-Jean Aubin,
- Esther M. Beraha,
- Fabio Caputo,
- Jonathan D. Chick,
- Jonathan D. Chick,
- Patrick de La Selle,
- Nicolas Franchitto,
- James C. Garbutt,
- Paul S. Haber,
- Paul S. Haber,
- Philippe Jaury,
- Anne R. Lingford-Hughes,
- Kirsten C. Morley,
- Christian A. Müller,
- Lynn Owens,
- Adam Pastor,
- Adam Pastor,
- Louise M. Paterson,
- Fanny Pélissier,
- Benjamin Rolland,
- Benjamin Rolland,
- Amanda Stafford,
- Andrew Thompson,
- Wim van den Brink,
- Lorenzo Leggio,
- Lorenzo Leggio,
- Lorenzo Leggio,
- Roberta Agabio
Affiliations
- Renaud de Beaurepaire
- Groupe Hospitalier Paul-Guiraud, Villejuif, France
- Julia M. A. Sinclair
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital Paisley, Paisley, United Kingdom
- Giovanni Addolorato
- AUD and Alcohol Related Diseases Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Giovanni Addolorato
- Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
- Henri-Jean Aubin
- Faculté de Médecine, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Sud, Paris, France
- Henri-Jean Aubin
- Faculté de Médecine, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France
- Henri-Jean Aubin
- Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Paris, France
- Henri-Jean Aubin
- Hôpitaux Universitaires Paris-Sud, Paris, France
- Esther M. Beraha
- 0Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
- Fabio Caputo
- 1Department of Internal Medicine, SS. Annunziata Hospital, Cento, Italy
- Jonathan D. Chick
- 2Castle Craig Hospital, Blyth Bridge, United Kingdom
- Jonathan D. Chick
- 3School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- Patrick de La Selle
- 4Private Practice, Montpellier, France
- Nicolas Franchitto
- 5Department of Addiction Medicine, Poisons and Substance Abuse Treatment Centre, Toulouse-Purpan University Hospital, Toulouse, France
- James C. Garbutt
- 6Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Paul S. Haber
- 7National Health Medical Research Council, Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Paul S. Haber
- 8Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Philippe Jaury
- 9Département de Médecine Générale, Faculté de Médecine, Université Paris Descartes, Paris, France
- Anne R. Lingford-Hughes
- 0Neuropsychopharmacology Unit, Division of Brain Sciences, Centre for Psychiatry, Imperial College London, London, United Kingdom
- Kirsten C. Morley
- 1Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Christian A. Müller
- 2Department of Psychiatry, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Lynn Owens
- 3Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, United Kingdom
- Adam Pastor
- 4Department Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Adam Pastor
- 5Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Louise M. Paterson
- 0Neuropsychopharmacology Unit, Division of Brain Sciences, Centre for Psychiatry, Imperial College London, London, United Kingdom
- Fanny Pélissier
- 6Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
- Benjamin Rolland
- 7Service Universitaire d'Addictologie de Lyon, Lyon, France
- Benjamin Rolland
- 8University of Lyon, Lyon, France
- Amanda Stafford
- 9Royal Perth Hospital, Perth, WA, Australia
- Andrew Thompson
- 3Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, United Kingdom
- Wim van den Brink
- 0Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam University, Amsterdam, Netherlands
- Lorenzo Leggio
- 1Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Division of Intramural Clinical and Basic Research, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
- Lorenzo Leggio
- 2Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
- Lorenzo Leggio
- 3Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
- Roberta Agabio
- 4Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
- DOI
- https://doi.org/10.3389/fpsyt.2018.00708
- Journal volume & issue
-
Vol. 9
Abstract
Alcohol use disorder (AUD) is a brain disorder associated with high rates of mortality and morbidity worldwide. Baclofen, a selective gamma-aminobutyric acid-B (GABA-B) receptor agonist, has emerged as a promising drug for AUD. The use of this drug remains controversial, in part due to uncertainty regarding dosing and efficacy, alongside concerns about safety. To date there have been 15 randomized controlled trials (RCTs) investigating the use of baclofen in AUD; three using doses over 100 mg/day. Two additional RCTs have been completed but have not yet been published. Most trials used fixed dosing of 30–80 mg/day. The other approach involved titration until the desired clinical effect was achieved, or unwanted effects emerged. The maintenance dose varies widely from 30 to more than 300 mg/day. Baclofen may be particularly advantageous in those with liver disease, due to its limited hepatic metabolism and safe profile in this population. Patients should be informed that the use of baclofen for AUD is as an “off-label” prescription, that no optimal fixed dose has been established, and that existing clinical evidence on efficacy is inconsistent. Baclofen therapy requires careful medical monitoring due to safety considerations, particularly at higher doses and in those with comorbid physical and/or psychiatric conditions. Baclofen is mostly used in some European countries and Australia, and in particular, for patients who have not benefitted from the currently used and approved medications for AUD.
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