Baclofen for Alcohol Cravings

Introduction to Baclofen Treatment

The European Association for the Study of the Liver (EASL) guidelines acknowledge that baclofen is among the most promising pharmacotherapies for alcohol use disorder, but emphasize important limitations 1, 2, 3, 4
Baclofen is the only alcohol pharmacotherapy specifically tested in patients with significant liver disease, including cirrhosis 1, 2, 5

The French National Agency for Medicines and Health Products (ANSM) has issued a temporary recommendation for baclofen use not exceeding 80 mg/day for alcohol use disorder 1, 2, 3, 4
Baclofen demonstrates a safe profile even in patients with liver cirrhosis, unlike naltrexone which carries hepatotoxicity risk 6, 7, 8, 5

The American College of Gastroenterology and the European Association for the Study of the Liver recommend baclofen as the preferred pharmacological option for patients with advanced liver disease 6, 7, 8, 9, 10, 5
Naltrexone (25 mg initially, then 50 mg daily for 3-12 months) is contraindicated in advanced liver disease due to hepatotoxicity risk 6, 7, 8, 5
Acamprosate (1,998 mg/day for ≥60 kg body weight, reduced by one-third for <60 kg) is effective but not tested in cirrhosis 6, 7, 8, 5

Brief motivational interventions remain the cornerstone of treatment and should be routinely used in all patients 9, 10, 1, 2, 3, 5, 4
These interventions reduce drinking by an average of a significant amount per week in men and should follow the "Five As" model: Ask, Advise, Assess, Assist, Arrange follow-up 9, 10, 1, 3, 4