Role of Baclofen in Alcohol Withdrawal Syndrome

Introduction to Baclofen and AWS

The American Association for the Study of Liver Diseases recommends benzodiazepines as the first-line treatment for alcohol withdrawal syndrome (AWS), but baclofen may be considered as an adjunctive therapy to reduce benzodiazepine requirements in selected patients, particularly those with liver impairment 1, 2

Benzodiazepines remain the gold standard treatment for AWS due to their proven efficacy in reducing withdrawal symptoms and preventing serious complications like seizures and delirium tremens, according to the American College of Gastroenterology 1, 3
Long-acting benzodiazepines (diazepam, chlordiazepoxide) provide better protection against seizures and delirium, while short and intermediate-acting benzodiazepines (lorazepam, oxazepam) are safer in elderly patients and those with hepatic dysfunction, as recommended by the American College of Gastroenterology 1, 3

Baclofen, a GABA-B receptor agonist, has been tested in the treatment of AWS with some promising results, according to the European Association for the Study of the Liver 1, 2

Most clinical guidelines, including those from the American College of Gastroenterology, do not include baclofen in their recommended protocols for AWS management 4, 5, 6, 7

Baclofen has a potential dual role in treatment, including short-term use for managing acute withdrawal symptoms and long-term use for maintaining alcohol abstinence after withdrawal, as suggested by the European Association for the Study of the Liver 4, 2
A 12-week course of baclofen effectively maintained abstinence by reducing alcohol craving in patients with liver cirrhosis, according to the American Association for the Study of Liver Diseases 4, 6

The French ANSM has issued a temporary recommendation for baclofen use not exceeding 80 mg/day for alcohol use disorder, and caution is advised in pregnant women as baclofen may accumulate and potentially cause neonatal withdrawal syndrome, as recommended by the European Medicines Agency 2, 8, 9

The American College of Gastroenterology recommends assessing AWS severity using validated tools like CIWA-Ar (scores >8 indicate moderate AWS, ≥15 indicate severe AWS) 1
For most patients, the American College of Gastroenterology recommends initiating benzodiazepine treatment as first-line therapy, and considering baclofen as an adjunctive treatment in specific situations, including patients with significant liver impairment or those requiring high doses of benzodiazepines 1, 3, 4, 2