Baclofen for Alcohol Use Disorder

What Is Baclofen?

Baclofen was first developed as a seizure medication, and was ultimately approved to treat muscle spasticity in the 1970s. The medication gained attention as a treatment for alcohol use disorder in the 2000s, when French cardiologist Olivier Ameisen successfully used it to cure his alcohol addiction.

Ameisen’s book “Le Dernier Verre,” translated as “the last glass” or “the end of my addiction,” brought public attention to this use of baclofen, and helped motivate further clinical research. It also inspired a number of people to try baclofen for themselves, leading to a community of people in recovery who advocate for this type of alcohol treatment.

While baclofen is an approved AUD treatment in France, it has yet to gain that specific FDA indication in the United States. That said, baclofen is still prescribed for alcohol use disorder in the US as an off-label medication (a medicine FDA-indicated for one function, but considered safe for another). A number of addiction specialists in the US prescribe baclofen, because when it works it seems to achieve very strong results.

How Does Baclofen Work?

We’re still learning exactly why baclofen works to reduce drinking, but it appears to help with imbalances in brain chemistry linked to chronic alcohol use. Here’s one of the main ways it seems to work:

• Baclofen activates the GABA-B receptors in the brain.
• When GABA receptors are activated, nerve cells become less likely to fire, which makes us feel sleepy and calm.
• Alcohol also activates GABA receptors, which is why some people feel calm after drinking.
• When you drink alcohol consistently, your body adapts to having alcohol stimulate GABA receptors, contributing to cravings when you don’t drink.
• By activating GABA receptors, baclofen may essentially “replace” alcohol for that purpose, reducing your motivation to drink.

Evidence For Baclofen as a Treatment for AUD

While research is ongoing, there is strong evidence that baclofen can reduce alcohol cravings and withdrawal symptoms for some people.

Multiple studies on rats and mice report a suppression of alcohol drinking, alcohol seeking, and the reinforcement of alcohol seeking when taking baclofen. The medication also appears to reduce some alcohol withdrawal symptoms, such as tremors, anxiety behaviors, and seizures. Research on non-human primates also shows a reduction in drinking when taking baclofen.

Some clinical trials involving people echo these results. A 2012 study, for example, found significant reductions in alcohol consumption among participants taking baclofen. However, a 2018 meta analysis found the results of baclofen inconsistent, stating that “current evidence remains uncertain regarding the use of baclofen as a first-line treatment for people with AUDs.” Although legal, baclofen has yet to receive specific FDA approval for AUD treatment.

At Ria Health, we’ve found baclofen to be a helpful and effective treatment option for some members with alcohol use disorder, and it is among the medications we prescribe to treat AUD. The usual starting dose is 5 mg three times a day, then increased to 10 mg three times a day. Occasionally, the dose may need to be increased to as much as 90 mg a day in divided doses.

How Do You Take Baclofen for Alcohol Use Disorder?

Baclofen is typically taken in tablet form. The amount prescribed can vary over time depending on your needs and what your physician feels will be most effective.

Typically, patients start off by taking the medication while drinking their normal amount of alcohol. Over time, cravings tend to diminish until a person reaches their goal. Although some people may still experience alcohol withdrawal, the symptoms are less intense, since baclofen seems to help treat these.

Baclofen For Patients With Liver Disease

If alcohol addiction goes untreated, it can lead to problems with how your liver functions, including liver disease. Unfortunately, people with liver disease are limited as to which medications they can take, since many drugs are metabolized in the liver.

Unlike many medications for alcohol use disorder, baclofen is primarily metabolized in the kidneys. This makes it a safer option for advanced liver disease patients who need to stop drinking.

Research supports baclofen as an option for people with liver disease. In one 2011 study, researchers divided patients with both hepatitis C infection and liver cirrhosis into two groups: those who would take a placebo (sugar pill) and those who would take baclofen. The baclofen group showed significantly higher rates of alcohol abstinence, as well as improvements in other markers of liver health.

Side Effects of Baclofen

The primary side effect of baclofen is sluggishness or drowsiness, but it can also cause:

• Fatigue
• Insomnia
• Weakness
• Dizziness
• Headache
• Frequent urination
• Upset stomach
• Constipation

In rare cases, some patients may experience chest pain, dark or bloody urine, depression, pounding heartbeat, visual or auditory hallucinations, slurred speech, fainting, or difficulties with muscle control. If any of these occur, you should contact a doctor immediately.

If you are pregnant or planning to become pregnant, let your doctor know before they prescribe this medication. The same is true if you have kidney disease, as this medication is processed through the kidneys.

Is Baclofen For You?

Baclofen May Be Helpful If:

• You experience withdrawal symptoms and cravings for alcohol
• You have liver disease and cannot take naltrexone
• You are also struggling with cocaine

Baclofen May Not Be Best If:

• You have kidney disease
• You work a physically demanding job and cannot take muscle relaxants

Baclofen is generally considered a safe medication, with few other drug interactions or toxicities. Because it is eliminated through the kidneys, it is among the better choices for people with liver diseases, including cirrhosis and hepatitis. There is evidence that baclofen can be used to treat other addictions as well, particularly cocaine, so it can be a good option if you struggle with both issues. Finally, like acamprosate and gabapentin, baclofen may help with insomnia and anxiety.

On the other hand, because baclofen doesn’t last very long in the body, it needs to be taken several times a day. And while it has been very effective for some people, clinical results have not been consistent, so it may not work for you. As a muscle relaxant, this medication may affect your ability to perform certain activities. Finally, there is the issue of withdrawal. Baclofen is not considered addictive, but people who take it for an extended period generally need to taper off of it.

In summary, baclofen is not yet considered a first-line medication for alcohol use disorder, but it is an effective solution for some people. If you are not reacting well to other medications for alcoholism, or if they aren’t helping, baclofen may be the right solution for you.

OTHER MEDICATIONS

Naltrexone | Disulfiram/Antabuse | Acamprosate | Gabapentin | Topiramate