Dr Renaud de Beaurepaire – Groupe Hospitalier Paul-Guiraud, Villejuif, France – Frontiers in Psychiatry – 10 ocotobre 2014
Baclofen, particularly high-dose baclofen, has recently emerged as a treatment of major interest for alcohol-dependence. However, baclofen has many potentially dangerous side effects, and the maximal dose of baclofen that may be used is a matter of discussion. Here, the author analyses the medical charts of the last 100 patients seen in his clinic, 17 of whom have been taking a very high dose of baclofen, which is to say, more than 300 mg/day. The analysis of the charts shows that the very high-doses baclofen were justified in almost all the cases. Side effects are analyzed.
High-dose baclofen has been shown to produce a remarkable state of indifference toward alcohol (1). However, the question of the upper limit of baclofen dosage that may be reached is a matter of discussion. Drug summaries recommend not exceeding the daily dose of 75–80 mg (75–80 mg/day) (2, 3) although long-term studies have shown that doses exceeding 250 or 300 mg/day are often necessary to produce a state of complete indifference to alcohol (4, 5). Recently, the French Health Safety Agency released a recommendation allowing for the prescription of baclofen to be given up to 300 mg/day, but not beyond, for the treatment of alcohol dependence (French Ministerial decree of June 13, 2014).
The present report is an analysis of the author’s medical charts of patients taking, or having taken, very high doses of baclofen, i.e., more than 300 mg/day for the treatment of their alcohol dependence. Since 2008, the author has prescribed baclofen to approximately 600 alcohol-dependent patients. The charts of the last 100 patients, followed for at least 6 months, were reviewed. At the time of the review (July 2014), all the patients except one (see Patient-14 below) were under the care of the author (last visit posterior to May 2014). Among the 100 charts, it appeared that 17 patients have been taking doses of baclofen superior to 300 mg/day at 1 time or another during their treatment (7 other patients reached the dose of 300 mg/day without exceeding it). This means that, according to this cohort, 17% of alcohol-dependent patients need more than 300 mg/day of baclofen for their treatment (and nearly one in four needs at least 300 mg/day).
Voir l’article sur Frontiers in Psychiatry : http://journal.frontiersin.org/Journal/10.3389/fpsyt.2014.00143/full