Baclofen for Alcohol Dependence in Patients with Cirrhosis

Some of the medications used to treat alcohol dependence are potentially hepatotoxic. Therefore, efficacious and safe alternatives to treat alcohol dependence in people with cirrhosis are desirable.

Researchers in this study assessed the safety and efficacy of baclofen, a muscle relaxant, in a 12-week randomized, placebo-controlled trial of 84 patients with cirrhosis and alcohol dependence who underwent detoxification. The medication was given by a family member who also checked adherence, side effects, and alcohol use. All patients received counseling.

• Baclofen patients were more likely than placebo patients to be abstinent (71% versus 29%).

• Baclofen patients also had greater improvements in liver-related blood tests (international normalized ratio, gamma-glutamyltransferase, alanine aminotransferase, albumin, and bilirubin).

• Side effects were similar in both groups, and none led patients to discontinue the medication.

Comments:

Some medications used to treat alcohol dependence are potentially hepatotoxic. Such toxicity, however, is not caused by acamprosate and generally not a concern with naltrexone at standard doses. Nonetheless, having another medication to treat alcohol dependence, particularly one that is not hepatotoxic, is useful. The effect of baclofen on abstinence in this study was impressive, although the sample was small and the study was short. If these results are confirmed in future studies, baclofen would be a welcome treatment option for alcohol dependence.

Richard Saitz, MD, MPH

Reference:

Addolorato G, Leggio L, Ferrulli A, et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet. 2007;370(9603):1915–1922.