Baclofen for Methamphetamine Cravings

Clinical Implementation

• The American College of Physicians recommends starting baclofen at 20 mg three times daily without titration in most patients 1

Critical Safety Warnings

• The American Medical Association advises to never abruptly discontinue baclofen once initiated, as withdrawal can cause life-threatening complications 2
• The American Medical Association recommends tapering baclofen slowly even in patients with complications 3

Contraindications and Precautions

• The National Institute of Neurological Disorders and Stroke suggests avoiding baclofen in patients with dementia or significant cognitive impairment, as it causes sedation and worsens mental status 1
• The National Kidney Foundation recommends avoiding baclofen in patients with renal dysfunction, since 75% is renally excreted and toxicity risk increases substantially 4
• The American Association for the Study of Liver Diseases advises avoiding baclofen in patients with hepatic encephalopathy or advanced liver disease, as baclofen impairs mentation 4
• The American Academy of Sleep Medicine recommends avoiding baclofen in patients with obstructive sleep apnea, as it promotes upper airway collapse 3, 1