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Cited by 24Alcoholism and Thiamine DeficiencySubstance Abuse Treatment and OutcomesAlcohol Consumption and Health Effects

Baclofen and the Alcohol Withdrawal Syndrome—A Short Review

Open access
Cooney, Gary, Heydtmann, Mathis, Smith, Iain D.·2019·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2018.00773PMC PMC6349735
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Abstract

The Alcohol Withdrawal Syndrome (AWS), which may occur with or without delirium, is a frequent consequence of sudden alcohol cessation in patients with moderate to severe Alcohol Dependence Syndrome (ADS). Withdrawal as a result of habituation to alcohol is part of the definition of the Alcohol Dependence Syndrome (ICD10). Since the recognition of Delirium Tremens, in the early nineteenth century, the management of the syndrome, an acute medical emergency, has proven controversial. The barbiturates, chlormethiazole, and recently the safer benzodiazepines transformed the management of these conditions. The benzodiazepines, particularly diazepam and chlordiazepoxide, are now the most used first line agents in the treatment of AWS. In addition, a number of other agents, including baclofen, a GABA-B receptor agonist, have the potential to suppress the alcohol withdrawal syndrome. In this review we review the potential use of baclofen in its role to treat AWS. We summarize initial case reports as well as more recent randomized trials of AWS treatment with baclofen. We conclude that currently there is not enough evidence to support the use of baclofen as a first line treatment for AWS. More research will be needed to determine where baclofen might have a role in second-line management of the Alcohol Withdrawal Syndrome on its own or in combination with benzodiazepines or other agents.

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  • Baclofen activates GABA-B receptors, leading to down-regulation of GABA-A activity, a negative feedback loop, and a decrease in excitatory neurotransmitters.

    “Baclofen’s mechanism of action involves the activation of the GABA-B receptor, leading to the down-regulation of GABA-A activity. This process establishes a negative feedback loop, ultimately resulting in a decrease in excitatory neurotransmitters, a parallel to the effects of alcohol [14].”

    From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [14]

    The ‘Background to Baclofen Use in AWS’ section says baclofen activates GABA-B receptors, which provide a negative feedback loop that downregulates GABA-A activity and mimics some effects of alcohol. The paper does not say this loop decreases excitatory neurotransmitters. Its ‘Alcohol Withdrawal Syndrome’ section attributes suppression of the excitatory system to alcohol’s action on NMDA receptors, not to baclofen. (LLM, conf=0.88)

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Research works printed but not linked: 2

  1. [6]NICE clinical guideline CG100 Alcohol-Use Disorders: Diagnosis and Management of Physical Complications (2010). 31999414
  2. [7]Taylor D Barnes TRE Young AH Chapter 4: The Maudsley Prescribing Guidelines in Psychiatry 13th Edition. Wiley Blackwell (2018).

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Authors
Cooney, G., Heydtmann, M., & Smith, I. D.
Affiliations
  • NHS Greater Glasgow and Clyde (GB)
  • Royal Alexandra Hospital (GB)
  • Gartnavel General Hospital (GB)
Corresponding author
Heydtmann, Mathis
ORCID
Smith, Iain D.
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2019-01-22
Volume
9
Pages
773-773
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2018.00773
PMC
PMC6349735
OpenAlex
W2912126342
Cited by
24
References
28
Citations by year
2025: 2 · 2024: 3 · 2023: 7 · 2022: 2 · 2021: 1 · 2020: 5 · 2019: 3 · 2017: 1
FWCI
1.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords
baclofen, alcohol withdrawal, alcoholism, delirium tremens, GABA-B receptor agonist, benzodiazepines, diazepam, chlordiazepoxide, barbiturates, chlormethiazole, second-line therapy

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