BRIEF REPORT

Assessing Alcohol Versus Baclofen Withdrawal Syndrome in Patients Treated With Baclofen for Alcohol Use Disorder Benjamin Rolland, MD, PhD,*Þþ Emmanuelle Jaillette, MD,*§ Louise Carton, MD,*Þ Camille Bence, MD,*Þ Sylvie Deheul, MD,þ Fabienne Saulnier, MD, PhD,*§ Re´gis Bordet, MD, PhD,*þ and Olivier Cottencin, MD, PhD*Þ Abstract: Baclofen is a F-aminobutyric acid B (GABA-B) receptor agonist that is approved for spasticity. Recently, the off-label use of baclofen for alcohol use disorder (AUD) has increased. However, baclofen is known to induce a neuroadaptation process, which may be identified by the occurrence of a specific baclofen withdrawal syndrome (BWS), that is, confusion, agitation, seizures, and delirium. The same set of symptoms characterizes alcohol withdrawal syndrome (AWS), which could lead to mistaking BWS for AWS in some situations. We report the cases of 3 patients under a chronic baclofen treatment for AUD. The patients emergently presented with a clinical state of confusion that was initially diagnosed and treated as AWS, with limited effect of benzodiazepines. Retrospectively, using a validated algorithm for assessing drug-induced withdrawal, we determined that all of these clinical cases were consistent with BWS. Both AWS and BWS should be considered in the case of acute confusion or delirium occurring in patients treated with baclofen for AUD. Moreover, further research should investigate to what extent GABA-A and GABA-B induce shared or distinct neuroadaptation processes and withdrawal syndromes. Key Words: baclofen, substance withdrawal syndrome, adverse drug event, alcohol withdrawal delirium, GABA-B receptors, GABA-A receptors (J Clin Psychopharmacol 2014;34: 153Y156)

he F-aminobutyric acid type B (GABA-B) receptor agonist baclofen is a long-standing medication for neurological spasticity that may be delivered orally or intrathecally.1 Recently, baclofen has emerged as a promising treatment to both reduce alcohol consumption and support abstinence.2,3 It has been hypothesized that this effect might be dose related,4Y6 which implies that high doses, that is, greater than 80 mg/d, may be used for alcohol use disorder (AUD).5Y7 However, baclofen may be responsible for inducing neuroadaptation, possibly resulting in baclofen withdrawal syndrome (BWS) in the case of sudden cessation of the drug.8 Baclofen withdrawal syndrome may occur following administration via either the intrathecal or oral route, and it manifests as agitation, fever, and confusion.9 Serious complications may occur, including rhabdomyolysis,10 psychosis,11 and seizures.12 A case of death was even reported following intrathecal use.9

T

From the *PRES Nord de France, Univ Lille Nord de France; and Departments of †Psychiatry and Addiction Medicine, ‡Pharmacology and Pharmacovigilance, and §Resuscitation Care, CHU Lille, Lille, France. Received March 24, 2013; accepted after revision July 9, 2013. Reprints: Benjamin Rolland, MD, PhD, Service d’Addictologie, Hoˆpital Fontan2, 1 rue Verhæghe, CS 70001, 59037 Lille Cedex, France (e

Assessing alcohol versus baclofen withdrawal syndrome in patients treated with baclofen for alcohol use disorder.

Baclofen is a γ-aminobutyric acid B (GABA-B) receptor agonist that is approved for spasticity. Recently, the off-label use of baclofen for alcohol use...
276KB Sizes 0 Downloads 0 Views