By Will Boggs MD
NEW YORK (Reuters Health) - Baclofen self-poisonings have risen in an era where it is increasingly used to treat patients with alcohol use disorder, researchers from France report.
"This increase is probably associated with the actual trend of treating alcohol use disorder with baclofen therapies,” Dr. Maxime Leger from Angers University Hospital, Angers Faculty of Health Sciences, in France, told Reuters Health by email. “Furthermore, we were surprised by the intensity of the sedation associated with baclofen intoxications and the high ratio of mechanical ventilation uses. It underlines the importance of the morbidity associated with baclofen self-poisonings.”
Baclofen, a selective agonist of gamma-aminobutyric acid (GABA), was originally used to treat central spasticity, but many practitioners are now using it for alcohol dependence, despite mixed results and an alarming safety profile.
Dr. Leger’s team retrospectively analyzed baclofen self-poisoning episodes in 190 reports - from all emergency departments and intensive care units of western France, representing a general population >12 million people - to the Poison Control Center (PCC) of the Angers University Hospital.
The findings were published online September 28 in Alcohol Alcoholism.
From 2008 to 2015, baclofen self-poisoning reported to the PCC increased 11.3-fold. Very few cases in 2008-2011 were related to baclofen prescription for alcohol use disorder, but these cases constituted the vast majority of self-poisonings from 2012 to 2015.
In all, 111 patients (59%) had Glasgow coma scores of 12 or lower (reflecting severe baclofen self-poisoning). Patients receiving baclofen for alcohol use disorder represented 84% of these patients, compared with 68% of patients with non-severe self-poisoning.
Patients with severe self-poisoning had higher suspected ingested doses, more frequently required admission to the ICU and mechanical ventilation, and more often had seizures, compared with patients who had non-severe self-poisoning.
Baclofen self-poisonings were significantly more likely than non-baclofen self-poisoning episodes to be associated with a requirement for mechanical ventilation (42.6% vs. 5.7%) and with death (2.6% vs. 0.1%).
“We can’t make a conclusion on the therapeutic (efficacy) of baclofen therapies to treat alcohol use disorder,” Dr. Leger said by email. “In addition to that, baclofen self-poisonings are associated with significant morbidity and mortality. Pending publications of strong results on the superiority of baclofen to treat alcohol dependence, baclofen shouldn’t be used in this particular indication.”
“If a practitioner wants to prescribe baclofen for alcohol dependence, I recommend being very cautious,” he said. “A psychiatric history must be investigated. A psychiatric follow-up must be organized. And all along the baclofen therapy, the benefit-risk ratio must be discussed.”
Alcohol Alcohol 2017.
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