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

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Title: The use of Baclofen as a treatment for alcohol use disorder: A clinical practice perspective
Authors: De Beaurepaire, R
Sinclair, JMA
Heydtmann, M
Addolorato, G
Aubin, H-J
Beraha, EM
Caputo, F
Chick, JD
De la Selle, P
Franchitto, N
Garbutt, JC
Haber, PS
Jaury, P
Lingford-Hughes, AR
Morley, KC
Muller, CA
Owens, L
Pastor, A
Paterson, LM
Pelissier, F
Rolland, B
Stafford, A
Thompson, A
Van den Brink, W
Leggio, L
Agabio, R
Item Type: Journal Article
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.
Issue Date: 4-Jan-2019
Date of Acceptance: 3-Dec-2018
URI: http://hdl.handle.net/10044/1/67451
DOI: https://dx.doi.org/10.3389/fpsyt.2018.00708
ISSN: 1664-0640
Publisher: Frontiers Media
Journal / Book Title: Frontiers in Psychiatry
Volume: 9
Copyright Statement: © 2019 de Beaurepaire, Sinclair, Heydtmann, Addolorato, Aubin, Beraha, Caputo, Chick, de La Selle, Franchitto, Garbutt, Haber, Jaury, Lingford-Hughes, Morley, Müller, Owens, Pastor, Paterson, Pélissier, 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 - https://creativecommons.org/licenses/by/4.0/). 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.
Sponsor/Funder: Medical Research Council (MRC)
Funder's Grant Number: G1002226
Keywords: Science & Technology
Life Sciences & Biomedicine
Psychiatry
GABA-B
baclofen
alcohol use disorder
efficacy
safety
HIGH-DOSE BACLOFEN
PLACEBO-CONTROLLED TRIAL
PRELIMINARY DOUBLE-BLIND
POSITIVE ALLOSTERIC MODULATOR
B RECEPTOR AGONIST
DEPENDENT PATIENTS
WITHDRAWAL SYNDROME
PHARMACOLOGICAL-TREATMENT
GABA(B) RECEPTOR
SUBSTANCE USE
Publication Status: Published
Article Number: 708
Online Publication Date: 2019-01-04
Appears in Collections:Department of Medicine (up to 2019)