Baclofen

Baclofen is a γ-aminobutyric-acid (GABA)B receptor agonist and is approved for the treatment of central spasticity. Baclofen is mostly excreted through the kidneys and therefore can be a potential pharmacotherapy for AUD patients with liver disease. There is some evidence baclofen treatment is associated with abstinence, however, reductions in heavy drinking has not been demonstrated. Current literature suggests that high dose ( >60 mg/day) baclofen is not more effective than low dose (30-60 mg/day) baclofen. Superiority over placebo has not been well established and the strength of the evidence for treatment efficacy is at this point lower than that of approved medications for the treatment of AUD.  

Baclofen is also associated with adverse effects including vertigo, somnolence/sedation, paraesthesia, and muscle spasms/rigidity. Sedation may occur even at low doses and safety concerns have been reported. Renal function needs to be evaluated before baclofen treatment given its renal excretion and contraindication in patients with kidney failure. Baclofen should be started at a low dose (5-10 mg three times per day) and slowly titrated upwards with caution due to the risks of sedation and overdose (e.g. 5-10 mg/day, every three days). Treatment with baclofen should be not abruptly interrupted to avoid the risk of withdrawal symptoms. The daily dose should be slowly reduced (e.g. 5-10 mg/day) to complete treatment. For patients with a risk of overdose, baclofen is relatively contraindicated, unless in a specialist setting and with controlled dispensing (eg weekly or daily dispenses).