How to Manage Self-Poisoning With Baclofen in Alcohol Use Disorder? Current Updates

Abstract

Specialists in addiction medicine continue to debate whether baclofen is still indicated to treat alcohol use disorders in view of conflicting results as to its efficacy. This review summarizes current knowledge on self-poisoning with baclofen focusing of alcohol-use disorder in order to provide an overview of the reliable scientific knowledge on management of such an intoxication. Moreover, as alcohol-dependent patients experience many psychiatric co-morbidities, the risk in suicide attempt using baclofen seems real. Numerous studies have suggested that patients given daily-doses of baclofen higher than 80 mg/day are more likely to attempt suicides than others. Following an ingestion of a large amount of baclofen, central nervous system depression is usually observed. Seizures require the patient to be admitted in intensive care unit and should be treated like other toxicological seizures. Cardiac complications include prolonged QTc interval, degree heart block, premature atrial contractions, and supraventricular tachycardia, hypotension and bradycardia. In cases of intoxication, the elimination half-life of baclofen may last between 12 and 36 h post-overdose and renal failure is known to delay its clearance. Rarely measured in clinical practice, the toxic level of baclofen blood level ranges from 1.1 to 3.5 mg/l, and coma or fatal intoxication are observed from 6 to 9.6 mg/l. Baclofen withdrawal has been observed but making the diagnosis of withdrawal in case of suspected self-poisoning is difficult as baclofen intoxication and baclofen withdrawal share many clinical signs. Admission to hospital to manage of suicide attempt with baclofen is mandatory and should not be limited to baclofen alone. It needs to include other aspects of the overall care of patients with alcohol disorders (psychological and psychosocial interventions, management of comorbid mental conditions and physical complications).

Baclofen therapeutics, toxicity, and withdrawal: A narrative review

“…While the expansion of baclofen’s use beyond the treatment of spasticity has been associated with an increased number of overdose and toxicity events, the most serious adverse outcomes have been associated with ITB administration. 3 , 62 – 72 It is important for providers to maintain a high diagnostic index of suspicion as the nature and severity of symptoms varies widely. Patient history, vital sign abnormalities, and physical examination findings are all important in establishing the diagnosis.…”

“…Plasma baclofen levels can be directly measured, although this is not commonly included on initial toxicology analyses. 3 , 88 The normal therapeutic blood plasma concentration with oral baclofen administration is 0.08–0.4 mg/L, while the toxic concentration is 1.1–3.5 mg/L. 89 The reported comatose-fatal concentration is 6.0–9.6 mg/L.…”

“…Both toxicity and withdrawal represent medical emergencies that carry a risk of death. 3 The purposes of this narrative review are to provide an overview of the common uses of baclofen in the clinical setting, assist providers with oral and intrathecal dosing regimens, and review the diagnosis and management of baclofen toxicity and withdrawal. Relevant English language references on baclofen administration, pharmacology, and adverse effects were reviewed.…”

The Use of Baclofen as a Treatment for Alcohol Use Disorder: A Clinical Practice Perspective

“…Accidental and intentional baclofen overdose presents a particular challenge and may be fatal or lead to coma and seizures requiring prolonged intensive care treatment (96, 102, 103). It is noteworthy that calls to the National Poisons Centre of France have escalated during the past decade, i.e., the period when minimally supervised baclofen use for AUD increased (99, 100, 104).…”

Targeting the Glucocorticoid Receptors During Alcohol Withdrawal to Reduce Protracted Neurocognitive Disorders

“…In spite of its promising effect in the treatment of protracted alcohol-related neurocognitive and motivational disorders, one might note that a limitation of the use of baclofen is associated with the determination of the relevant dose to induce beneficial effects without negative side disorders (116) such as cognitive and emotional disorders, which have been reported with high doses (133). Its use in humans might require closet medical surveillance given the pathological alterations associated with self-misuse or high doses of this compound.…”