The use of baclofen as a treatment for alcohol use disorder: a clinical practice perspective

de Beaurepaire R

First

Member of the Collaboration Group

;Sinclair JM

Second

Member of the Collaboration Group

;Heydtmann M

Member of the Collaboration Group

;Addolorato G

Member of the Collaboration Group

;Aubin H-J

Member of the Collaboration Group

;Beraha E

Member of the Collaboration Group

;Caputo F

Member of the Collaboration Group

;Chick JD

Member of the Collaboration Group

;De La Selle P

Member of the Collaboration Group

;Franchitto N

Member of the Collaboration Group

;Garbutt J

Member of the Collaboration Group

;Haber PS

Member of the Collaboration Group

;Jaury P

Member of the Collaboration Group

;Lingford-Hughes A

Member of the Collaboration Group

;Morley K

Member of the Collaboration Group

;Müller CA

Member of the Collaboration Group

;Owens L

Member of the Collaboration Group

;Pastor A

Member of the Collaboration Group

;Paterson LM

Member of the Collaboration Group

;Pelissier F

Member of the Collaboration Group

;Rolland B

Member of the Collaboration Group

;Stafford A

Member of the Collaboration Group

;Thompson A

Member of the Collaboration Group

;Van Den Brink W

Member of the Collaboration Group

;Leggio L

Penultimate

Member of the Collaboration Group

;Agabio R

Last

Member of the Collaboration Group

2019-01-01

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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.