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Baclofen in the Treatment of Alcohol Use Disorder

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Front. Psychiatry | doi: 10.3389/fpsyt.2018.00708

THE USE OF BACLOFEN AS A TREATMENT FOR ALCOHOL USE DISORDER: A CLINICAL PRACTICE PERSPECTIVE

  • 1Groupe hospitalier Paul Guiraud (GHPG), France
  • 2Faculty of Medicine, University of Southampton, United Kingdom
  • 3Royal Alexandra Hospital, United Kingdom
  • 4Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Italy
  • 5INSERM U1018 Centre de recherche en Épidémiologie et Santé des Populations, France
  • 6Institut National de la Santé et de la Recherche Médicale (INSERM), France
  • 7Hôpitaux universitaires Paris-Sud (APHP), France
  • 8Faculté de Médecine, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France, France
  • 9Department of Psychology, University of Amsterdam, Netherlands
  • 10Ospedale SS Annunziata, Italy
  • 11Castle Craig Hospital, United Kingdom
  • 12School of Health & Social Care, Edinburgh Napier University, United Kingdom
  • 13Private practice Montpellier, France, France
  • 14Centre de soins d’accompagnement et de prévention en addictologie, Pôle psychiatrie, Centre Hospitalier Universitaire (CHU) de Toulouse, France
  • 15Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, United States
  • 16National Health and Medical Research Council (NHMRC), Australia
  • 17Royal Prince Alfred Hospital, Australia
  • 18Département de Médecine Générale, Faculté de Médecine, Université Paris Descartes, France
  • 19Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom
  • 20Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Australia, Australia
  • 21Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Charité Campus Mitte, Germany
  • 22Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom
  • 23Department of Addiction Medicine, St Vincent’s Hospital, Australia
  • 24Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
  • 25Hôpital Purpan, France
  • 26Service Universitaire d’Addictologie de Lyon, Centre Hospitalier Le Vinatier, France
  • 27University of Lyon, Lyon, France, France
  • 28Royal Perth Hospital, Australia
  • 29Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands
  • 30Intramural Research Program (NIDA), United States
  • 31Center for Alcohol and Addiction Studies, Brown University, United States
  • 32Sezione di Neuroscienze e Farmacologia Clinica, Dipartimento di scienze biomediche, Università degli studi di Cagliari, Italy

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.

Keywords: GABA-B, Baclofen, Alcohol use disorder (AUD), efficacy, Safety -

Received: 05 Oct 2018; Accepted: 03 Dec 2018.

Edited by:

Alain Dervaux, Centre Hospitalier Universitaire (CHU) de Amiens, France

Reviewed by:

Henriette Walter, Medical University of Vienna, Austria
Teresa R. Franklin, University of Pennsylvania, United States  

Copyright: © 2018 de Beaurepaire, Sinclair, Heydtmann, Addolorato, Aubin, Beraha, Caputo, Chick, De La Selle, Franchitto, Garbutt, Haber, Jaury, Lingford-Hughes, Morley, Müller, Owens, Pastor, Paterson, PELISSIER, ROLLAND, Stafford, Thompson, Van Den Brink, Leggio and Agabio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Roberta Agabio, Sezione di Neuroscienze e Farmacologia Clinica, Dipartimento di scienze biomediche, Università degli studi di Cagliari, Cagliari, Italy, agabio@unica.it