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Baclofen (Lioresal ®)

NEW YORK STATE OFFICE OF ALCOHOLISM AND SUBTANCE ABUSE SERVICES
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Addiction Medicine FYI

Baclofen (Lioresal®)

Baclofen, known as Lioresal®, is a GABAB receptor agonist (GABA is the predominant inhibitory neurotransmitter in the brain) that is used to alleviate the signs and symptoms of muscle spasticity from Multiple Sclerosis. It is thought to inhibit transmission of reflexes at the spinal cord level. Off-label uses of Baclofen include treatment of trigeminal neuralgia, tardive dyskinesia and intractable hiccups.

In alcohol and opiate withdrawal, one can see a heightened level of vital signs and a highly excitable state. With agonist properties similar to an inhibitory neurotransmitter, it is hoped that this medication will reverse some of the signs and symptoms of withdrawal in the alcohol and opiate dependent patient.

Initial alcohol research has found that Baclofen can reduce voluntary intake of alcohol by rats, decrease alcohol craving and alcohol withdrawal syndrome intensity in alcohol dependent patients ( Am J of Med 2002 - a small study using 10 mg as an initial dose and 10 mg every 8 hours for 30 days in 5 patients). Work presented in the Alc Clin Exp Res issue (2000) supported Baclofen as reducing alcohol intake due to its anti - craving properties.

In opiate research, Baclofen was tested in comparison to Clonidine for treatment of opiate withdrawal. Presented in the J Clin Pharm Ther (2001), 62 opiate dependent patients were treated with either Baclofen or Clonidine for a 14-day, double blind trial. Maximum doses of Baclofen were 40mg per day and 0.8 mg of Clonidine per day (This appears to be a fairly low dose for opiate withdrawal treatment). The findings showed no significant difference between the two groups as to retention in treatment or side - effects, though the Clonidine group had more problems with hypotension.

There is also research using Baclofen for cocaine dependence, looking at the GABA modulation of cocaine self-administration and Baclofen's ability to reduce this. As published in the Dec. 15 edition of the peer-reviewed Journal of Clinical Psychiatry, the randomized, double-blind study, funded by the National Institute on Drug Abuse as part of a project to screen medications with potential for treating cocaine dependence, found that Baclofen used in conjunction with substance abuse counseling significantly reduced cocaine use in recovering addicts compared to placebo coupled with counseling. UCLA Neuropsychiatric Institute, Dec. 15, 2003

Baclofen is available in tablets with the initial dose of 5 mg three times a day to a maximum of 80 mg per day for treatment of muscle spasticity. Hallucinations and seizures have occurred on abrupt withdrawal of Baclofen. Side - effects have included: somnolence, dizziness, paresthesia, nausea, vomiting, headache and constipation. There is a report of a Baclofen overdose (300 mg with alcohol) which led to severe respiratory depression requiring airway and respiratory support.

REFERENCES

  1. Baclofen versus Clonidine in the treatment of opiates withdrawal, side-effects aspect: a double blind randomized controlled trial. J Clin Pharm Ther 2001 Feb;26(1):67-71
  2. Ability of baclofen in reducing alcohol craving and intake: II--Preliminary clinical evidence. Alcohol Clin Exp Res 2000 Jan;24(1):67-71
  3. Ability of baclofen in reducing alcohol intake and withdrawal severity: I--Preclinical evidence. Alcohol Clin Exp Res 2000 Jan;24(1):58-66
  4. GABA modulation of cocaine self-administration. Ann N Y Acad Sci 2000;909:145-58
  5. Baclofen and ethanol ingestion: a case report. J Emerg Med 1999 Nov-Dec;17(6):989-93

12/03