1
|
Pelerin JM, Fristot L, Gibaja V, Revol B, Gillet P, Lima-Tournebize J. Non-medical use of baclofen: A case series and review of the literature. Therapie 2023; 78:615-637. [PMID: 36922285 DOI: 10.1016/j.therap.2023.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/11/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Baclofen is widely used for spastic disorders and, most recently, for addictive disorders. The first signals of baclofen abuse occurred in the last decade. This study aims to assess the motives, diversion sources, and routes of administration associated with the non-medical use of baclofen and examine health problems related to the non-medical use of baclofen. METHODS Spontaneous reports of baclofen abuse reported to the addictovigilance centre of East France were analysed. A literature search was conducted using PubMed®, Web of Sciences®, and Google Scholar® databases. Both investigations were performed in February 2021 without a time limit. RESULTS Forty-six cases were analysed (33 from the literature review and 13 from the addictovigilance base). Baclofen's non-medical use mainly affected male subjects with addictive history, but issues of primary abuse in subjects without any substance abuse history were also observed. Euphoria search was the most common reason for misuse. The route of administration included oral, snorting, and sublingual use. Some cases involving illegal sources were also observed. Most patients misusing baclofen presented severe complications, mainly represented by neurological and respiratory disturbances. Physical and psychological dependence on baclofen was observed in three persons. CONCLUSIONS Although baclofen abuse remains relatively infrequent or (most likely) underestimated, this study helped confirm baclofen's intrinsic abuse potential and make visible the baclofen-abuse-related health visible harms. Careful consideration and benefit-risk analysis should be employed when prescribing baclofen, and emergency departments should be aware of baclofen dangers in abuse situations.
Collapse
Affiliation(s)
- Jean-Marc Pelerin
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France
| | - Lisa Fristot
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France
| | - Valérie Gibaja
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France; French Addictovigilance Network (FAN), 33000 Bordeaux, France
| | - Bruno Revol
- French Addictovigilance Network (FAN), 33000 Bordeaux, France; CEIP-Addictovigilance, university hospital of Grenoble, 38000 Grenoble, France
| | - Pierre Gillet
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France; Université de Lorraine, CNRS, IMoPA, 54000 Nancy, France
| | - Juliana Lima-Tournebize
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France; French Addictovigilance Network (FAN), 33000 Bordeaux, France.
| |
Collapse
|
2
|
Fischler PV, Soyka M, Seifritz E, Mutschler J. Off-label and investigational drugs in the treatment of alcohol use disorder: A critical review. Front Pharmacol 2022; 13:927703. [PMID: 36263121 PMCID: PMC9574013 DOI: 10.3389/fphar.2022.927703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Compounds known to be successful in the treatment of alcohol use disorder include the aversive agent, Disulfiram, the glutamatergic NMDA receptor antagonist, Acamprosate, and the opioid receptor antagonists, Naltrexone and Nalmefene. Although all four are effective in maintaining abstinence or reduction of alcohol consumption, only a small percentage of patients receive pharmacological treatment. In addition, many other medications have been investigated for their therapeutic potential in the treatment of alcohol use disorder. In this review we summarize and compare Baclofen, Gabapentin, Topiramate, Ondansetron, Varenicline, Aripiprazole, Quetiapine, Clozapine, Antidepressants, Lithium, Neuropeptide Y, Neuropeptide S, Corticotropin-releasing factor antagonists, Oxytocin, PF-05190457, Memantine, Ifenprodil, Samidorphan, Ondelopran, ABT-436, SSR149415, Mifepristone, Ibudilast, Citicoline, Rimonabant, Surinabant, AM4113 and Gamma-hydroxybutyrate While some have shown promising results in the treatment of alcohol use disorder, others have disappointed and should be excluded from further investigation. Here we discuss the most promising results and highlight medications that deserve further preclinical or clinical study. Effective, patient-tailored treatment will require greater understanding provided by many more preclinical and clinical studies.
Collapse
Affiliation(s)
- Pascal Valentin Fischler
- Department for Gynecology and Obstetrics, Women’s Clinic Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- *Correspondence: Pascal Valentin Fischler,
| | - Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Erich Seifritz
- Director of the Clinic for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Clinic Zürich, Zürich, Switzerland
| | | |
Collapse
|
3
|
Romanova OL, Chauhan M, Blagonravov ML, Kislov MA, Ershov AV, Krupin KN. Baclofen (fun drug) and ethanol combined poisoning in humans: A histopathology and morphometry model. J Forensic Leg Med 2022; 90:102373. [PMID: 35671675 DOI: 10.1016/j.jflm.2022.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/01/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND - This study intends to address the scarcity of data regarding the pathogenesis of Baclofen poisoning in humans, which has seen a recent increase, worldwide, especially amongst the young people. Another reason for the conduction of this study was lack of the substantial data about the histo-pathological findings of lungs, in synergistic toxicity of Baclofen with Ethanol, in-spite of it being very common in humans, and both being respiratory depressant with similar mechanism of action. PURPOSE - The authors aimed to understand the pathogenesis of fatal poisonings in humans due to Baclofen in combination with Ethanol via an animal research model. The enhancement of the overall scientific literature by extending research along the lines of the handful studies available in this regard was another adjunct goal of the study. MATERIAL AND METHODS Fifteen Wistar rats were divided into control and test group of five and ten subjects respectively. The test group was further divided into two sub-groups of five each, with Baclofen administered to one, and it in conjunction with Ethanol to the other, in lowest dosages adjusted for the humans. Rats in both the groups were euthanized by dislocation of the cervical vertebrae for the histopathology examination. RESULTS Capillary and venous plethora, hemorrhages in the inter-alveolar septi, hemorrhages into the alveoli and sludging was seen in the 1st sub-group. The plethora of venules, capillaries and arterioles, with sludging by the WBC (white blood corpuscle) infiltrates was seen in the 2nd sub-group. Desquamation of the ciliated epithelium and edematous thickening of the intra-alveolar septi, along with features suggestive of the peri-vascular edema was seen in the 2nd sub-group. The morphometric analysis of the micro vessels showed a significantly higher value of the arteriolar diameter in the 2nd sub-group, in comparison to 1st, but the venular diameter in the two sub-groups did not differ to any extent.
Collapse
Affiliation(s)
- O L Romanova
- Department of General Physiology, Medical Institute of Russian University of People Friendship, Research Institute of Human Morphology, Moscow, Russia.
| | - M Chauhan
- Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, Chandigarh, 160030, India.
| | - M L Blagonravov
- Department of General Pathology and Pathological Physiology, Medical Institute of Russian University of People Friendship, Moscow, Russia.
| | - M A Kislov
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - A V Ershov
- Institute of General Resuscitation Named After V. A. Negovsky Federal State Budgetary Scientific Institution, Federal Scientific and Clinical Center of Reаnimatology and Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - K N Krupin
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| |
Collapse
|
4
|
Recommendations from the EXTRIP workgroup on extracorporeal treatment for baclofen poisoning. Kidney Int 2021; 100:720-736. [PMID: 34358487 DOI: 10.1016/j.kint.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/04/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Baclofen toxicity results from intentional self-poisoning ("acute baclofen poisoning") or accumulation of therapeutic dose in the setting of impaired kidney function. Standard care includes baclofen discontinuation, respiratory support and seizure treatment. Use of extracorporeal treatments (ECTRs) is controversial. To clarify this, a comprehensive review of the literature on the effect of ECTRs in baclofen toxicity was performed and recommendations following EXTRIP methods were formulated based on 43 studies. (1 comparative cohort, 1 aggregate results cohort, 1 pharmacokinetic modeling, and 40 patient reports or series). Toxicokinetic data were available for 20 patients. Baclofen's dialyzability is limited by a high endogenous clearance and a short half-life in patients with normal kidney function. The workgroup assessed baclofen as "Moderately dialyzable" by intermittent hemodialysis for patients with normal kidney function (quality of evidence C) and "Dialyzable" for patients with impaired kidney function (quality of evidence C). Clinical data were available for 25 patients with acute baclofen poisoning and 46 patients with toxicity from therapeutic baclofen in kidney impairment. No deaths or sequelae were reported. Mortality in historical controls was rare. No benefit of ECTR was identified in patients with acute baclofen poisoning. Indirect evidence suggests a benefit of ECTR in reducing the duration of toxic encephalopathy from therapeutic baclofen in kidney impairment. These potential benefits were balanced against added costs and harms related to the insertion of a catheter, the procedure itself, and the potential of baclofen withdrawal. Thus, the EXTRIP workgroup suggests against performing ECTR in addition to standard care for acute baclofen poisoning and suggests performing ECTR in toxicity from therapeutic baclofen in kidney impairment, especially in the presence of coma requiring mechanical ventilation.
Collapse
|
5
|
Baclofen self-poisoning: Is renal replacement therapy efficient in patient with normal kidney function? Anaesth Crit Care Pain Med 2020; 39:813-817. [DOI: 10.1016/j.accpm.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022]
|
6
|
Reynoard J, Schmitt C, Torrents R, Simon N. Toxicological considerations in the prescription of baclofen for the treatment of substance use disorders. Expert Opin Drug Metab Toxicol 2020; 16:309-317. [PMID: 32149546 DOI: 10.1080/17425255.2020.1740681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: For many years, applications for baclofen have widened in the treatment of substance abuse disorder (SUD), mainly alcohol use disorder, with a growing rate of off-label prescriptions in Europe. Clinical effects seem to be both a decrease of craving and anxiety, leading to a decrease of drug or alcohol consumption. We described baclofen poisoning circumstances, therapeutic options and outcomes when used in substance use disorders.Areas covered: This review summarizes the toxicological considerations where baclofen was prescribed in humans for substance use or abuse disorder in randomized clinical trials, case series, case reports and observational studies between 1990 and 2020 according to the Preferred Reporting Items for Systemic reviews and Meta-Analysis.Expert opinion: The most frequent cause of severe intoxication is self-poisoning. A dose above 180 mg are expected to cause severe toxicity and death. The treatment is only symptomatic as no antidote is available. Off-label prescription remains unsafe because the optimal dose is not known and varies greatly between patients. As SUD are frequently associated with psychiatric disorders and such patients may have suicidal thoughts, the risk of self-poisoning is high. Potential co-ingestants should also be considered, especially CNS depressants, and they need to be closely monitored.
Collapse
Affiliation(s)
- Julien Reynoard
- Pharmacologie Clinique CAP-TV, APHM, Hôpitaux Sud, Marseille, France
| | - Corinne Schmitt
- Pharmacologie Clinique CAP-TV, APHM, Hôpitaux Sud, Marseille, France
| | - Romain Torrents
- APHM, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite Pharmacologie Clinique CAP-TV, Aix Marseille Univ, Marseille, France
| | - Nicolas Simon
- APHM, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite Pharmacologie Clinique CAP-TV, Aix Marseille Univ, Marseille, France
| |
Collapse
|
7
|
Abstract
BACKGROUND Alcohol withdrawal syndrome (AWS) is a distressing and life-threatening condition that usually affects people who are alcohol dependent when they discontinue or decrease their alcohol consumption. Baclofen shows potential for rapidly reducing symptoms of severe AWS in people with alcoholism. Treatment with baclofen is easy to manage and rarely produces euphoria or other pleasant effects, or craving for the drug. This is an updated version of the original Cochrane Review first published in 2011 and last updated in 2017. OBJECTIVES To assess the efficacy and safety of baclofen for people with AWS. SEARCH METHODS We updated our searches of the following databases to June 2019: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, PubMed, Embase, and CINAHL. We also searched registers of ongoing trials. We handsearched the references quoted in the identified trials, and sought information from researchers, pharmaceutical companies, and relevant trial authors about unpublished or uncompleted trials. We placed no restrictions on language. SELECTION CRITERIA We included all randomised controlled clinical trials (RCTs) evaluating baclofen versus placebo or any other treatment for people with AWS. We excluded uncontrolled, non-randomised, or quasi-randomised trials. We included both parallel group and cross-over studies. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included four RCTs with 189 randomised participants (one RCT new for this update). None of the included studies reported the primary outcomes of alcohol withdrawal seizures, alcohol withdrawal delirium, or craving. For the comparison of baclofen and placebo (1 study, 31 participants), there was no evidence of a difference in Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) scores in eight-hour periods from days one to five (very low-quality evidence). For the comparison of baclofen and diazepam (2 studies, 85 participants), there was no evidence of a difference in change from baseline to days 10 to 15 on CIWA-Ar scores (very low-quality evidence, meta-analysis was not performed due to insufficient data). In one study (37 participants), there was no evidence of a difference in participants with at least one adverse event (risk difference (RD) 0.00, 95% confidence interval (CI) -0.10 to 0.10; very low-quality evidence), dropouts (RD 0.00, 95% CI -0.10 to 0.10; very low-quality evidence), and dropouts due to adverse events (RD 0.00, 95% CI -0.10 to 0.10; very low-quality evidence). For the comparison of baclofen and chlordiazepoxide (1 study, 60 participants), there was no evidence of a difference in difference from baseline to nine-day decremental fixed-dose intervention: CIWA-Ar scores (mean difference (MD) 1.00, 95% CI 0.70 to 1.30; very low-quality evidence), global improvement (MD 0.10, 95% CI -0.03 to 0.23; very low-quality evidence), 14/60 participants with adverse events (RD 2.50, 95% CI 0.88 to 7.10; very low-quality of evidence), dropouts (RD 0.00, 95% CI -0.06 to 0.06; very low-quality evidence), and dropouts due to adverse events (RD 0.00, 95% CI -0.06 to 0.06; very low-quality evidence). None of the RCTs provided information on random sequence generation or allocation concealment, therefore, we assessed them at unclear risk of bias. Two RCTs were not of double-blind design and had a high risk of bias in blinding (Addolorato 2006; Girish 2016). One RCT had more than 5% dropouts with high risk of attrition bias (Lyon 2011). We could not assess reporting bias as none of the prepublished protocols were available. AUTHORS' CONCLUSIONS No conclusions can be drawn about the efficacy and safety of baclofen for the management of alcohol withdrawal because we found insufficient and very low-quality evidence.
Collapse
Affiliation(s)
- Jia Liu
- Xuanwu Hospital, Capital Medical UniversityDepartment of NeurologyChangchun Street 45BeijingChina100053
| | - Lu‐Ning Wang
- Chinese PLA General HospitalDepartment of Geriatric NeurologyFuxing Road 28Haidian DistrictBeijingChina100853
| | | |
Collapse
|
8
|
Chartier M, Tannous S, Benturquia N, Labat L, Reis R, Risède P, Chevillard L, Mégarbane B. Baclofen-Induced Neuro-Respiratory Toxicity in the Rat: Contribution of Tolerance and Characterization of Withdrawal Syndrome. Toxicol Sci 2019; 164:153-165. [PMID: 29945230 DOI: 10.1093/toxsci/kfy073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Baclofen, a γ-amino-butyric acid type-B receptor agonist with exponentially increased use at high-dose to facilitate abstinence in chronic alcoholics, is responsible for increasing poisonings. Tolerance and withdrawal syndromes have been reported during prolonged treatment but their contribution to the variability of baclofen-induced neurotoxicity in overdose is unknown. We studied baclofen-induced effects on rat sedation, temperature, and ventilation and modeled baclofen pharmacokinetics and effect/concentration relationships aiming to investigate the consequences of repeated baclofen pretreatment and to characterize withdrawal syndrome. Baclofen-induced dose-dependent sedation (p <0.01), hypothermia (p <.001) and respiratory depression (p <.01) were altered in repeatedly baclofen-pretreated rats (p <.05). Repeatedly baclofen-pretreated rats did not exhibit respiratory depression following baclofen overdose due to limitations on baclofen-induced increase in inspiratory (p <.01) and expiratory times (p <.01). Only slight hypoxemia without respiratory acidosis was observed. Baclofen discontinuation resulted in hyperlocomotion and non-anxiogenic withdrawal symptoms. Regarding pharmacokinetics, repeated baclofen pretreatment increased the peak concentration (p <.05) and absorption constant rate (p <.05) and reduced the distribution volume (p <.0001) and elimination half-life (p <.05). Analysis of the effect/concentration relationships indicated that plasma baclofen concentration decreases more rapidly than all studied neuro-respiratory effects, in tolerant and non-tolerant rats. Taken together, our findings supported the role of brain distribution in baclofen-induced neurotoxicity expression and its probable involvement in tolerance-related attenuation in addition to physiological adaptations of ventilation. In conclusion, repeated pretreatment attenuates baclofen-attributed neurotoxicity in overdose and results in post-discontinuation withdrawal syndrome. Our findings suggest both pharmacodynamic and pharmacokinetic mechanisms whose relative contributions to the variability of baclofen-induced neurotoxicity in overdose remain to be established.
Collapse
Affiliation(s)
- Magali Chartier
- Inserm, UMRS-1144, Paris-Descartes University, 75006 Paris, France
| | - Salma Tannous
- Inserm, UMRS-1144, Paris-Descartes University, 75006 Paris, France
| | - Nadia Benturquia
- Inserm, UMRS-1144, Paris-Descartes University, 75006 Paris, France
| | - Laurence Labat
- Inserm, UMRS-1144, Paris-Descartes University, 75006 Paris, France.,Pharmacokinetics and Pharmacochemistry Unit, Cochin Hospital, 75010 Paris, France.,Laboratory of Toxicology, Lariboisière Hospital, 75010 Paris, France
| | - Rafael Reis
- Pharmacokinetics and Pharmacochemistry Unit, Cochin Hospital, 75010 Paris, France
| | - Patricia Risède
- Inserm, UMRS-1144, Paris-Descartes University, 75006 Paris, France
| | - Lucie Chevillard
- Inserm, UMRS-1144, Paris-Descartes University, 75006 Paris, France
| | - Bruno Mégarbane
- Inserm, UMRS-1144, Paris-Descartes University, 75006 Paris, France.,Department of Medical and Toxicological Critical Care, Lariboisière Hospital, 75010 Paris, France
| |
Collapse
|
9
|
Hachimi A, ElBahja S, Rachda S, Fajri M, Abjaw Z, Boukoub N, ElKhayari M. Oral baclofen poisoning with normal renal function: A new case and review of the literature. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Jamshidi N, Morley KC, Cairns R, Dawson A, Haber PS. A Review of Baclofen Overdoses in Australia: Calls to a Poisons Information Centre and a Case Series. Alcohol Alcohol 2018; 54:73-78. [DOI: 10.1093/alcalc/agy082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 10/29/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Nazila Jamshidi
- Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia
| | - Kirsten C Morley
- School of Medicine, NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, NSW, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, Australia
| | - Andrew Dawson
- Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, Australia
- Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Sydney
| | - Paul S Haber
- Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia
- School of Medicine, NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, NSW, Australia
- Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Sydney
| |
Collapse
|
11
|
Chartier M, Malissin I, Tannous S, Labat L, Risède P, Mégarbane B, Chevillard L. Baclofen-induced encephalopathy in overdose - Modeling of the electroencephalographic effect/concentration relationships and contribution of tolerance in the rat. Prog Neuropsychopharmacol Biol Psychiatry 2018; 86:131-139. [PMID: 29782961 DOI: 10.1016/j.pnpbp.2018.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/31/2022]
Abstract
Baclofen, a γ-amino-butyric acid type-B receptor agonist with exponentially increased use at high-dose to facilitate abstinence in chronic alcoholics, is responsible for increasing poisonings. Baclofen overdose may induce severe encephalopathy and electroencephalographic (EEG) abnormalities. Whether prior prolonged baclofen treatment may influence the severity of baclofen-induced encephalopathy in overdose has not been established. We designed a rat study to characterize baclofen-induced encephalopathy, correlate its severity with plasma concentrations and investigate the contribution of tolerance. Baclofen-induced encephalopathy was assessed using continuous EEG and scored based on a ten-grade scale. Following the administration by gavage of 116 mg/kg baclofen, EEG rapidly and steadily impaired resulting in the successive onset of deepening sleep followed by generalized periodic epileptiform discharges and burst-suppressions. Thereafter, encephalopathy progressively recovered following similar phases in reverse. Periodic triphasic sharp waves, non-convulsive status epilepticus and even isoelectric signals were observed at the most critical stages. Prior repeated baclofen administration resulted in reduced severity (peak: grade 7 versus 9; peak effect length: 382 ± 40 versus 123 ± 14 min, P = 0.008) and duration of encephalopathy (18 versus > 24 h, P = 0.0007), supporting the acquisition of tolerance. The relationship between encephalopathy severity and plasma baclofen concentrations fitted a sigmoidal Emax model with an anticlockwise hysteresis loop suggesting a hypothetical biophase site of action. The baclofen concentration producing a response equivalent to 50% of Emax was significantly reduced (8947 μg/L, ±11.3% versus 12,728 μg/L, ±24.0% [mean, coefficient of variation], P = 0.03) with prior prolonged baclofen administration. In conclusion, baclofen overdose induces early-onset and prolonged marked encephalopathy that is significantly attenuated by prior repeated baclofen treatment. Our findings suggest a possible role for the blood-brain barrier in the development of tolerance; however, its definitive involvement remains to be demonstrated.
Collapse
Affiliation(s)
| | - Isabelle Malissin
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, Paris, France
| | - Salma Tannous
- Inserm UMRS-1144, Paris-Descartes University, Paris, France
| | - Laurence Labat
- Inserm UMRS-1144, Paris-Descartes University, Paris, France; Pharmacokinetics and Pharmaco-chemistry Unit, Cochin Hospital, Paris, France; Laboratory of Toxicology, Lariboisière Hospital, Paris, France
| | | | - Bruno Mégarbane
- Inserm UMRS-1144, Paris-Descartes University, Paris, France; Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, Paris, France.
| | | |
Collapse
|
12
|
Simon N, Moirand R, Dematteis M, Bordet R, Deplanque D, Rolland B. Full-Profile Pharmacokinetic Study of High Dose Baclofen in Subjects With Alcohol Use Disorder. Front Psychiatry 2018; 9:385. [PMID: 30190685 PMCID: PMC6115517 DOI: 10.3389/fpsyt.2018.00385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/31/2018] [Indexed: 12/20/2022] Open
Abstract
Baclofen a gamma amino-butyric acid type B (GABA-B) receptor agonist, which has raised some interest for the treatment of alcohol use disorder (AUD), occasionally at dose up to 300 mg/d. We conducted the first full-profile pharmacokinetic study on baclofen in AUD subjects, up to the oral daily dose of 300 mg. Sixty subjects treated for AUD with marketed baclofen were enrolled in a prospective phase-1 study. Participants were divided into four dose groups (1: <60 mg/d; 2: 60-120 mg/d; 3: >120 mg/d-180 mg/d; and 4: >180 mg/d), and they underwent a full-profile pharmacokinetic analysis of baclofen, using a nonlinear mixed effects modeling. The influence of different clinical and biological covariates was assessed in an upward modeling. Fifty-seven participants completed the study (522 observed concentrations collected). Racemic baclofen showed a linear pharmacokinetic profile, corresponding to a one-compartment model, with no influencing clinical or biological factor. The pharmacokinetic parameters of baclofen were (bootstrap 95% confidence intervals): absorption constant (Ka) 1.64 1/h (1.34-2), clearance (Cl/F) 11.6 L/h (10.8-12.3) and volume of distribution (Vd/F) 72.8 L (66.5-80.4) leading to a half-life of 4.4 h. The interindividual variability (IIV) was 44% (19-65), 21% (16-27), and 22% (11-36) for Ka, Cl/F, and Vd/F, respectively. The residual variability was 24% (21-26). No serious adverse event was reported. Registration: EudraCT #2013-003412-46.
Collapse
Affiliation(s)
- Nicolas Simon
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Service de Pharmacologie Clinique, CAP-TV, Marseille, France
| | - Romain Moirand
- Univ Rennes, INSERM, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), CIC 1414, Unité d'Addictologie, Rennes, France
| | - Maurice Dematteis
- UFR de Médecine, Université Grenoble Alpes, Grenoble, France
- Service d'Addictologie, CHU Grenoble Alpes, Grenoble, France
| | - Régis Bordet
- Inserm U1171, Université de Lille, Lille, France
| | - Dominique Deplanque
- Inserm U1171, Université de Lille, Lille, France
- Inserm CIC1403, CHU Lille, Université de Lille, Lille, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le VInatier, Bron, France
- Université de Lyon, Inserm U1028, CNRS UMR5292, UCBL, CRNL, Bron, France
| |
Collapse
|
13
|
Franchitto N, Rolland B, Pelissier F, Simon N. How to Manage Self-Poisoning With Baclofen in Alcohol Use Disorder? Current Updates. Front Psychiatry 2018; 9:417. [PMID: 30233433 PMCID: PMC6132193 DOI: 10.3389/fpsyt.2018.00417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/14/2018] [Indexed: 12/20/2022] Open
Abstract
Specialists in addiction medicine continue to debate whether baclofen is still indicated to treat alcohol use disorders in view of conflicting results as to its efficacy. This review summarizes current knowledge on self-poisoning with baclofen focusing of alcohol-use disorder in order to provide an overview of the reliable scientific knowledge on management of such an intoxication. Moreover, as alcohol-dependent patients experience many psychiatric co-morbidities, the risk in suicide attempt using baclofen seems real. Numerous studies have suggested that patients given daily-doses of baclofen higher than 80 mg/day are more likely to attempt suicides than others. Following an ingestion of a large amount of baclofen, central nervous system depression is usually observed. Seizures require the patient to be admitted in intensive care unit and should be treated like other toxicological seizures. Cardiac complications include prolonged QTc interval, degree heart block, premature atrial contractions, and supraventricular tachycardia, hypotension and bradycardia. In cases of intoxication, the elimination half-life of baclofen may last between 12 and 36 h post-overdose and renal failure is known to delay its clearance. Rarely measured in clinical practice, the toxic level of baclofen blood level ranges from 1.1 to 3.5 mg/l, and coma or fatal intoxication are observed from 6 to 9.6 mg/l. Baclofen withdrawal has been observed but making the diagnosis of withdrawal in case of suspected self-poisoning is difficult as baclofen intoxication and baclofen withdrawal share many clinical signs. Admission to hospital to manage of suicide attempt with baclofen is mandatory and should not be limited to baclofen alone. It needs to include other aspects of the overall care of patients with alcohol disorders (psychological and psychosocial interventions, management of comorbid mental conditions and physical complications).
Collapse
Affiliation(s)
- Nicolas Franchitto
- Department of Addiction Medicine, Toulouse-Purpan University Hospital, Toulouse, France.,Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France.,UMR 1027, Paul Sabatier University, Toulouse, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Pôle MOPHA, CH Le Vinatier, Bron, France.,Univ Lyon, Inserm U1028, CNRS UMR5292, UCBL, CRNL, Lyon, France
| | - Fanny Pelissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Nicolas Simon
- APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Service de Pharmacologie Clinique, CAP-TV, Aix Marseille Univ, Marseille, France
| |
Collapse
|
14
|
Thompson A, Owens L, Richardson P, Pirmohamed M. Systematic review: Baclofen dosing protocols for alcohol use disorders used in observational studies. Eur Neuropsychopharmacol 2017; 27:1077-1089. [PMID: 28939163 DOI: 10.1016/j.euroneuro.2017.08.434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/10/2017] [Accepted: 08/30/2017] [Indexed: 01/15/2023]
Abstract
The popularity of baclofen as an anti-craving agent in the treatment of alcohol use disorders (AUDs) has increased, especially in patients with established liver disease. However, evidence-based guidelines to inform practice are lacking. The aim of this systematic review is explore the prescribing practices of baclofen in AUD treatment. Electronic databases were searched for relevant articles from 2002. Assessment of eligibility criteria for inclusion was performed independently by two investigators. The main outcomes of interest were maximum dose, starting dose, titration regimen, effectiveness, and tolerability. Twenty-five studies reporting outcomes in 613 patients treated with baclofen for an AUD were identified. Starting doses ranged between 5 and 50mg/d. Titration was study-dependent, and doses were increased until either therapeutic target (abstinence or study-defined low risk drinking) was achieved or adverse events resulted in a dose reduction or discontinuation. The maximum dose for individual patients ranged between 20 and 630mg/d. Seven studies reported at least one patient using >300mg/d. In studies with 10 or more patients, we found a negative correlation between dose and proportion of patients achieving the therapeutic goal. However, this was skewed by one study. A range of serious adverse events were reported. Most were reported at doses over 100mg/d, but others presented at lower doses. Baclofen is a promising therapeutic in this area. Evidence is required, however, to support practitioners in prescribing doses that optimise outcomes and reduce adverse events.
Collapse
Affiliation(s)
- Andrew Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom.
| | - Lynn Owens
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom; Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, Prescot Street, United Kingdom
| | - Paul Richardson
- Gastroenterology and Hepatology, Royal Liverpool University Hospital Trust, Ward 5z Link, Prescot Street, United Kingdom
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom
| |
Collapse
|
15
|
Abstract
BACKGROUND Baclofen shows potential for rapidly reducing symptoms of severe alcohol withdrawal syndrome (AWS) in people with alcoholism. Treatment with baclofen is easy to manage and rarely produces euphoria or other pleasant effects, or craving for the drug. This is an updated version of the original Cochrane Review published in 2015, Issue 4. OBJECTIVES To assess the efficacy and safety of baclofen for people with AWS. SEARCH METHODS We updated our searches of the following databases to March 2017: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, PubMed, Embase, and CINAHL. We also searched registers of ongoing trials. We handsearched the references quoted in the identified trials, and sought information from researchers, pharmaceutical companies, and relevant trial authors about unpublished or uncompleted trials. We placed no restrictions on language. SELECTION CRITERIA We included all randomised controlled clinical trials (RCTs) evaluating baclofen versus placebo or any other treatment for people with AWS. We excluded uncontrolled, non-randomised, or quasi-randomised trials. We included both parallel group and cross-over studies. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included three RCTs with 141 randomised participants. We did not perform meta-analyses due to the different control interventions. For the comparison of baclofen and placebo (1 study, 31 participants), there was no significant difference in Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) scores (very low quality evidence). For the comparison of baclofen and diazepam (1 study, 37 participants), there was no significant difference in CIWA-Ar scores (very low quality evidence), adverse events (risk difference (RD) 0.00, 95% confidence interval (CI) -0.10 to 0.10; very low quality evidence), dropouts (RD 0.00, 95% CI -0.10 to 0.10; very low quality evidence), and dropouts due to adverse events (RD 0.00, 95% CI -0.10 to 0.10; very low quality evidence). For the comparison of baclofen and chlordiazepoxide (1 study, 60 participants), there was no significant difference in CIWA-Ar scores (mean difference (MD) 1.00, 95% CI 0.70 to 1.30; very low quality evidence), global improvement (MD 0.10, 95% CI -0.03 to 0.23; very low quality evidence), adverse events (RD 2.50, 95% CI 0.88 to 7.10; very low quality of evidence), dropouts (RD 0.00, 95% CI -0.06 to 0.06; very low quality evidence), and dropouts due to adverse events (RD 0.00, 95% CI -0.06 to 0.06; very low quality evidence). AUTHORS' CONCLUSIONS No conclusions can be drawn about the efficacy and safety of baclofen for the management of alcohol withdrawal because we found insufficient and very low quality evidence.
Collapse
Affiliation(s)
- Jia Liu
- Xuanwu Hospital, Capital Medical UniversityDepartment of NeurologyChangchun Street 45BeijingChina100053
| | - Lu‐Ning Wang
- Chinese PLA General HospitalDepartment of Geriatric NeurologyFuxing Road 28Haidian DistrictBeijingChina100853
| |
Collapse
|
16
|
Pelissier F, de Haro L, Rolland B, Franchitto N. Severity of Baclofen Self-Poisoning Linked to Psychiatric Co-morbidity in Alcohol-Dependent Patients: Better Measurement of Risk and Benefit. Basic Clin Pharmacol Toxicol 2017; 121:217-219. [PMID: 28693052 DOI: 10.1111/bcpt.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny Pelissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Luc de Haro
- Poison Control Center, Clinical Pharmacology Department, Sainte Marguerite Hospital, Marseille, France
| | - Benjamin Rolland
- Department of Psychiatry and Addictology, Lille University Hospital, Lille, France
| | - Nicolas Franchitto
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France.,Department of Addiction Medicine, Toulouse-Purpan University Hospital, Toulouse, France
| |
Collapse
|
17
|
Issa SY, Hafez EM, El-Banna AS, Abdel Rahman SM, AlMazroua MK, El-Hamd MA. Baclofen systemic toxicity: Experimental histopathological and biochemical study. Hum Exp Toxicol 2017; 37:431-441. [PMID: 28565970 DOI: 10.1177/0960327117712369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The present study was designed to highlight the toxic impact of baclofen on both biochemical and histopathological aspects in rats' liver, gastric, lung, kidney, and brain tissues. METHODS The study was performed on 30 healthy adult male albino rats divided into four groups with 5 rats in each control group, and 10 rats in either experimental groups (two experimental and two control groups). Five rats (negative control) were kept in a quite non-stressful environment, provided with food ad libitum and free access to water. Normal saline (1 ml) was given orally as placebo in the positive control group ( n = 5). Experimental group III, baclofen acute toxicity group (10 rats): Each animal received a single dose of lethal dose (LD50) of baclofen orally by gavage. It equals 145 mg/kg body weight. The rats were observed for acute toxicity manifestations as well as for LD50 deaths. Group IV, (baclofen-dependent group, 10 rats): Each animal received baclofen (1/10th LD50) in gradually increasing doses for 1 month. RESULTS The levels of blood urea nitrogen, creatinine kinase, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, cardiac troponin I, and prothrombin time in both baclofen-treated groups showed significant elevation when compared to controls. There were brain, lung, gastric, hepatic, and renal histopathological changes in baclofen-treated rats whose severity varied between the two experimental groups. CONCLUSION AND RECOMMENDATION Baclofen toxicity is an under diagnosed emergency. Physicians should consider baclofen toxicity in users having hepatorenal dysfunction, presenting with altered mental status, bradycardia, and hypotension.
Collapse
Affiliation(s)
- S Y Issa
- 1 Faculty of Medicine, Department of Forensic Medicine and Clinical Toxicology, Alexandria University, Alexandria, Egypt
| | - E M Hafez
- 2 Faculty of Medicine, Department of Forensic Medicine and Clinical Toxicology, Minia University, Minia, Egypt
| | - A S El-Banna
- 1 Faculty of Medicine, Department of Forensic Medicine and Clinical Toxicology, Alexandria University, Alexandria, Egypt
| | | | - M K AlMazroua
- 4 Dammam Poison Control Center, MOH-KSA, Dammam, Saudi Arabia
| | - M A El-Hamd
- 2 Faculty of Medicine, Department of Forensic Medicine and Clinical Toxicology, Minia University, Minia, Egypt
| |
Collapse
|
18
|
Ghosh S, Bhuyan D. Baclofen Abuse due to Its Hypomanic Effect in Patients with Alcohol Dependence and Comorbid Major Depressive Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:187-189. [PMID: 28449569 PMCID: PMC5426491 DOI: 10.9758/cpn.2017.15.2.187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/18/2022]
Abstract
Baclofen is a gamma-aminobutyric acid type B receptor agonist used as an anti-craving agent for treatment of alcohol dependence. It has gained popularity in the recent times because it is well tolerated even in patients with hepatic impairments. Herein we are summarizing the latest literature about baclofen induced hypomania and are reporting a case of baclofen abuse because of its mood elevating property in a patient of alcohol dependence with comorbid major depressive disorder. Literature review and case study of a 36-year-old male with alcohol dependence with comorbid major depressive disorder was prescribed with tablet baclofen as an anti-craving agent along with antidepressant medicines. The patients who did not improve with conventional antidepressant therapy started feeling better in terms of his mood symptoms on taking tablet baclofen. Owing to the mood elevating property he started abusing baclofen. Despite its safety profile in hepatic impairment, one must be very cautious in prescribing baclofen because of its mood altering property which may account for its abuse potentiality.
Collapse
Affiliation(s)
- Soumitra Ghosh
- Department of Psychiatry, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Dhrubajyoti Bhuyan
- Department of Psychiatry, Assam Medical College and Hospital, Dibrugarh, Assam, India
| |
Collapse
|
19
|
Soyka M, Kranzler HR, Hesselbrock V, Kasper S, Mutschler J, Möller HJ. Guidelines for biological treatment of substance use and related disorders, part 1: Alcoholism, first revision. World J Biol Psychiatry 2017; 18:86-119. [PMID: 28006997 DOI: 10.1080/15622975.2016.1246752] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
These practice guidelines for the biological treatment of alcohol use disorders are an update of the first edition, published in 2008, which was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). For this 2016 revision, we performed a systematic review (MEDLINE/PUBMED database, Cochrane Library) of all available publications pertaining to the biological treatment of alcoholism and extracted data from national guidelines. The Task Force evaluated the identified literature with respect to the strength of evidence for the efficacy of each medication and subsequently categorised it into six levels of evidence (A-F) and five levels of recommendation (1-5). Thus, the current guidelines provide a clinically and scientifically relevant, evidence-based update of our earlier recommendations. These guidelines are intended for use by clinicians and practitioners who evaluate and treat people with alcohol use disorders and are primarily concerned with the biological treatment of adults with such disorders.
Collapse
Affiliation(s)
- Michael Soyka
- a Psychiatric Hospital Meiringen , Meiringen , Switzerland.,b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany.,c Medicalpark Chiemseeblick , Bernau , Germany
| | - Henry R Kranzler
- d Crescenz VAMC , University of Pennsylvania and VISN 4 MIRECC , Philadelphia , PA , USA
| | | | - Siegfried Kasper
- f Department of Psychiatric Medicine , University of Vienna, Vienna , Austria
| | - Jochen Mutschler
- a Psychiatric Hospital Meiringen , Meiringen , Switzerland.,g Psychiatric Hospital University of Zürich, Zürich , Switzerland
| | - Hans-Jürgen Möller
- b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany
| | | |
Collapse
|
20
|
Pelissier F, de Haro L, Cardona F, Picot C, Puskarczyk E, Sapori JM, Tournoud C, Franchitto N. Self-poisoning with baclofen in alcohol-dependent patients: national reports to French Poison Control Centers, 2008–2013. Clin Toxicol (Phila) 2017; 55:275-284. [DOI: 10.1080/15563650.2017.1284330] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Fanny Pelissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Luc de Haro
- Poison Control Center, Clinical Pharmacology Department, Sainte Marguerite Hospital, Marseille, France
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
| | - Florence Cardona
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- French National Agency for Medicines and Health Products Safety (ANSM), Saint Denis, France
| | - Cyndie Picot
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- French National Agency for Medicines and Health Products Safety (ANSM), Saint Denis, France
| | - Emmanuel Puskarczyk
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Poison Information and Toxicovigilance Center, Nancy University Medical Center, Nancy, France
| | - Jean-Marc Sapori
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Toxicovigilance and Poison Control Center, Hospices Civils de Lyon, Lyon, France
| | - Christine Tournoud
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Poison Information and Toxicovigilance Center, Hôpital Civil, Strasbourg, France
| | - Nicolas Franchitto
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
- Groupe de Travail Toxicovigilance des Médicaments, ANSM, Saint Denis, France
- Comité de Coordination de Toxicovigilance, Institut de Veille Sanitaire (InVS), Saint Maurice, France
- Department of Addiction Medicine, Toulouse-Purpan University Hospital, Toulouse, France
| |
Collapse
|
21
|
Rolland B, Auffret M, Labreuche J, Lapeyre-Mestre M, Dib M, Kemkem A, Grit I, Drelon M, Duhamel A, Cabe N, Vabret F, Guillin O, Baguet A, Masquelier C, Dervaux A, Deheul S, Bordet R, Carton L, Cottencin O, Jardri R, Gautier S. Phone-based safety monitoring of the first year of baclofen treatment for alcohol use disorder: the BACLOPHONE cohort study protocol. Expert Opin Drug Saf 2016; 16:125-132. [PMID: 27984918 DOI: 10.1080/14740338.2017.1270939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND In France, baclofen is frequently used off-label for alcohol use disorder (AUD). Baclofen has been associated with diverse adverse events (AEs), but the causality of these AEs has never been properly assessed. METHODS/DESIGN BACLOPHONE is a prospective multicenter cohort study conducted in the Hauts-de-France and Normandie French regions. BACLOPHONE consists of the phone-based monitoring of 792 patients during their first year of baclofen treatment for AUD. Two initial phone interviews assess the medical history, current medications, and substance use as well as complete the alcohol use identification test (AUDIT) and severity of alcohol dependence questionnaire (SADQ). Daily alcohol use and baclofen doses are noted throughout the follow-up. For every reported AE, additional phone interviews determine the seriousness of the AE, the causality of baclofen using validated causality algorithms, and the final outcome. The main objective of the study is to determine the rate of patients who stop baclofen due to an AE during the first year of treatment. DISCUSSION BACLOPHONE will provide important safety data on baclofen as a complement to the forthcoming efficacy data of randomized clinical trials.
Collapse
Affiliation(s)
- Benjamin Rolland
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France.,b Service d'Addictologie, CHU Lille , Lille , France
| | - Marine Auffret
- c Centre Régional de Pharmacovigilance, CHU Lille , Lille , France
| | - Julien Labreuche
- d Plateforme d'Aide Méthodologique , Biostatistique et Datamanagement, CHU Lille , Lille , France
| | - Maryse Lapeyre-Mestre
- e Service de Pharmacologie Clinique, CEIP-Addictovigilance, CIC 1436, CHU de ToulouseUMR-INSERM 1027 Universite Paul Sabatier - Toulouse 3 , Toulouse , France
| | - Malek Dib
- f Fédération de Recherche Clinique, CHU Lille , Lille , France
| | - Aomar Kemkem
- f Fédération de Recherche Clinique, CHU Lille , Lille , France
| | - Isabelle Grit
- f Fédération de Recherche Clinique, CHU Lille , Lille , France
| | - Marie Drelon
- g Centre d'Investigation Clinique, CHU Lille , Lille , France
| | - Alain Duhamel
- d Plateforme d'Aide Méthodologique , Biostatistique et Datamanagement, CHU Lille , Lille , France.,h CERIM, EA 2694, Univ Lille , Lille , France
| | - Nicolas Cabe
- i Service d'Addictologie, CHU de Caen , Caen , France
| | | | - Olivier Guillin
- k Centre Hospitalier du Rouvray, CHU de Rouen , Rouen , France
| | | | - Céline Masquelier
- p Centre Hospitalier Regional Universitaire de Lille Ringgold standard institution - Biostatistics CHU Lille , Lille , France
| | - Alain Dervaux
- l Service d'Addictologie, CHU d'Amiens , Amiens , France
| | - Sylvie Deheul
- m Centre d'Evaluation et d'Information sur les Pharmacodépendances, CHU Lille , Lille , France
| | - Régis Bordet
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France.,c Centre Régional de Pharmacovigilance, CHU Lille , Lille , France.,m Centre d'Evaluation et d'Information sur les Pharmacodépendances, CHU Lille , Lille , France
| | - Louise Carton
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France
| | - Olivier Cottencin
- b Service d'Addictologie, CHU Lille , Lille , France.,n SCALab UMR CNRS 9193, Univ Lille , Lille , France
| | - Renaud Jardri
- n SCALab UMR CNRS 9193, Univ Lille , Lille , France.,o Centre Universitaire de Recherche et d'Exploration, CHU Lille , Lille , France
| | - Sophie Gautier
- a Département de Pharmacologie Médicale , INSERM U 1171, Univ Lille , Lille , France.,c Centre Régional de Pharmacovigilance, CHU Lille , Lille , France
| |
Collapse
|
22
|
Pélissier F, Claudet I, Gandia-Mailly P, Benyamina A, Franchitto N. Cannabis Hyperemesis Syndrome in the Emergency Department: How Can a Specialized Addiction Team Be Useful? A Pilot Study. J Emerg Med 2016; 51:544-551. [PMID: 27485997 DOI: 10.1016/j.jemermed.2016.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic cannabis users may experience cyclical episodes of nausea and vomiting and learned behavior of hot bathing. This clinical condition, known as cannabis hyperemesis syndrome, was first reported in 2004. OBJECTIVE Our aim was to promote early recognition of this syndrome in emergency departments (EDs) and to increase referral to addiction specialists. METHODS Cannabis abusers were admitted to the ED for vomiting or abdominal pain from June 1, 2014 to January 1, 2015 and diagnosed with cannabis hyperemesis syndrome by a specialized addiction team. Then, medical records were examined retrospectively. RESULTS Seven young adults were included. Their mean age was 24.7 years (range 17-39 years) and the majority were men (male-to-female ratio 1.2). Biological and toxicological blood samples were taken in all patients. Tetrahydrocannabinol blood level was measured in 4 patients, with a mean blood concentration of 11.6 ng/mL. Radiographic examination including abdominal computed tomography and brain imaging were negative, as was upper endoscopy. Five patients compulsively took hot baths in an attempt to decrease the symptoms. Treatment was symptomatic. Five patients have started follow-up with the specialized addiction team. CONCLUSIONS Cannabis hyperemesis syndrome is still under-diagnosed 10 years after it was first described. Physicians should be aware of this syndrome to avoid repeated hospitalizations or esophageal complications. Greater awareness should lead to prompt treatment and prevention of future recurrence through cannabis cessation. Addiction specialists, as well as medical toxicologists, are experts in the management of cannabis abusers and can help re-establish the role of medical care in this population in collaboration with emergency physicians.
Collapse
Affiliation(s)
- Fanny Pélissier
- Poisons Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Isabelle Claudet
- Pediatric Emergency Unit, Children's Hospital, CHU Toulouse, Toulouse, France
| | - Peggy Gandia-Mailly
- Laboratory of Pharmacokinetics and Clinical Toxicology, Institute of Biology, University Hospital of Toulouse, Toulouse, France
| | - Amine Benyamina
- National Institute for Medical Research (INSERM) U-669, Hôpital Universitaire Paul Brousse, Villejuif, France
| | - Nicolas Franchitto
- Poisons Center, Toulouse-Purpan University Hospital, Toulouse, France; Department of Addiction Treatments, Toulouse-Purpan University Hospital, Toulouse, France; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1027, Paul Sabatier University, Toulouse, France
| |
Collapse
|
23
|
Geoffroy PA, Rolland B. Does baclofen have antidepressant qualities? Encephale 2016; 42:384-5. [PMID: 27216595 DOI: 10.1016/j.encep.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/13/2015] [Indexed: 11/19/2022]
Affiliation(s)
- P A Geoffroy
- Inserm, UMR-S 1144, 75006 Paris, France; Service de psychiatrie adulte, pôle neurosciences, groupe hospitalier Saint-Louis-Lariboisière-Fernand Widal, AP-HP, 200, rue du Faubourg-Saint-Denis, 75475 Paris cedex 10, France; UMR-S 1144, université Paris Descartes, 75006 Paris, France; UMR-S 1144, université Paris Diderot, 75013 Paris, France; Fondation FondaMental, 94000 Créteil, France.
| | - B Rolland
- Inserm U 1171, université de Lille, 59045 Lille, France; Service d'addictologie, CHRU de Lille, 59037 Lille, France
| |
Collapse
|
24
|
Rolland B, Auffret M, Franchitto N. Safety reports on the off-label use of baclofen for alcohol-dependence: recommendations to improve causality assessment. Expert Opin Drug Saf 2016; 15:747-51. [DOI: 10.1517/14740338.2016.1168397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Benjamin Rolland
- Service d’Addictologie, CHU Lille, Lille, France
- Département de Pharmacologie Médicale INSERM U,1171, Univ Lille, Lille, France
| | - Marine Auffret
- Centre Régional de Pharmacovigilance, INSERM U1171, CHU Lille, Lille, France
| | | |
Collapse
|
25
|
Baclofen intoxication cases in an intensive care unit. Anaesth Crit Care Pain Med 2016; 35:169-70. [DOI: 10.1016/j.accpm.2015.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 11/21/2022]
|
26
|
Safety and Tolerability of Pharmacological Treatment of Alcohol Dependence: Comprehensive Review of Evidence. Drug Saf 2016; 39:627-45. [DOI: 10.1007/s40264-016-0416-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
27
|
High doses of Baclofen as suicide attempt in patients with alcohol use disorders - A serious concern. Asian J Psychiatr 2015; 17:99-100. [PMID: 26264491 DOI: 10.1016/j.ajp.2015.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/25/2015] [Indexed: 11/22/2022]
Abstract
Baclofen is increasingly being used as an off label anti-craving agent in alcohol use disorders in various parts of the world. The lack of proper recommendations regarding the dosage has important implications for safety in clinical management. In this context, we report two patients who were started with Baclofen as an anti-craving agent, and later developed serious complications following acute self inflicted overdose. We also highlight the important mechanisms of such complications and precautions that needs to be exerted while prescribing.
Collapse
|
28
|
Cleophax C, Goncalves A, Chasport C, de Beaugrenier E, Labat L, Declèves X, Mégarbane B. Usefulness of plasma drug monitoring in severe baclofen poisoning. Clin Toxicol (Phila) 2015; 53:923-4. [DOI: 10.3109/15563650.2015.1088158] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
29
|
Reichmuth P, Blanc AL, Tagan D. Unintentional baclofen intoxication in the management of alcohol use disorder. BMJ Case Rep 2015; 2015:bcr2015212187. [PMID: 26396128 PMCID: PMC4593270 DOI: 10.1136/bcr-2015-212187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/04/2022] Open
Abstract
In recent years, there has been a growing interest in using baclofen for the management of alcohol use disorder. This off-label indication usually involves high doses of the medication. We report a case of severe baclofen overdose in a 66-year-old man. The patient was found severely agitated, and he presented with delirium and auditory hallucinations. At hospital admission, his daily dose was 180 mg baclofen. He was admitted to the intensive care unit for sedation and supportive care. When sedation was withdrawn, the patient presented with a normal neurological status. In this clinical context, baclofen intoxication was suspected. This was confirmed by measuring blood baclofen levels. This intoxication was probably mediated by a combination of risk factors including a high daily dose of baclofen and acute renal failure, conducive to drug accumulation.
Collapse
Affiliation(s)
- Philipp Reichmuth
- Department of Internal Medicine, Riviera-Chablais Hospital, Vevey, Switzerland
| | - Anne-Laure Blanc
- Clinical Pharmacy, Pharmacie des Hôpitaux de l'Est Lémanique, Vevey, Switzerland
| | - Damien Tagan
- Department of Internal Medicine, Riviera-Chablais Hospital, Vevey, Switzerland
| |
Collapse
|
30
|
Müller CA, Geisel O, Pelz P, Higl V, Krüger J, Stickel A, Beck A, Wernecke KD, Hellweg R, Heinz A. High-dose baclofen for the treatment of alcohol dependence (BACLAD study): a randomized, placebo-controlled trial. Eur Neuropsychopharmacol 2015; 25:1167-77. [PMID: 26048580 DOI: 10.1016/j.euroneuro.2015.04.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/13/2015] [Accepted: 04/01/2015] [Indexed: 01/17/2023]
Abstract
Previous randomized, placebo-controlled trials (RCTs) assessing the efficacy of the selective γ-aminobutyric acid (GABA)-B receptor agonist baclofen in the treatment of alcohol dependence have reported divergent results, possibly related to the low to medium dosages of baclofen used in these studies (30-80mg/d). Based on preclinical observations of a dose-dependent effect and positive case reports in alcohol-dependent patients, the present RCT aimed to assess the efficacy and safety of individually titrated high-dose baclofen for the treatment of alcohol dependence. Out of 93 alcohol-dependent patients initially screened, 56 were randomly assigned to a double-blind treatment with individually titrated baclofen or placebo using dosages of 30-270mg/d. The multiple primary outcome measures were (1) total abstinence and (2) cumulative abstinence duration during a 12-week high-dose phase. More patients of the baclofen group maintained total abstinence during the high-dose phase than those receiving placebo (15/22, 68.2% vs. 5/21, 23.8%, p=0.014). Cumulative abstinence duration was significantly higher in patients given baclofen compared to patients of the placebo group (mean 67.8 (SD 30) vs. 51.8 (SD 29.6) days, p=0.047). No drug-related serious adverse events were observed during the trial. Individually titrated high-dose baclofen effectively supported alcohol-dependent patients in maintaining alcohol abstinence and showed a high tolerability, even in the event of relapse. These results provide further evidence for the potential of baclofen, thereby possibly extending the current pharmacological treatment options in alcohol dependence.
Collapse
Affiliation(s)
- Christian A Müller
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Olga Geisel
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Patricia Pelz
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Verena Higl
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Josephine Krüger
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Stickel
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anne Beck
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Rainer Hellweg
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
31
|
Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD; BDO): A literature review with a focus on UK fatalities related to non-medical use. Neurosci Biobehav Rev 2015; 53:52-78. [PMID: 25843781 DOI: 10.1016/j.neubiorev.2015.03.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 03/08/2015] [Accepted: 03/25/2015] [Indexed: 11/22/2022]
|
32
|
Abstract
BACKGROUND The treatment baclofen shows potential for rapidly reducing symptoms of severe alcohol withdrawal syndrome (AWS) in people with alcoholism. Treatment with baclofen is easy to manage and rarely produces euphoria or other pleasant effects, or craving for the drug. This is an updated version of the original Cochrane review published in Issue 2, 2013. OBJECTIVES To assess the efficacy and safety of baclofen for people with AWS. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (searched 13 January 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), and CINAHL (1982 to January 2015). We also searched registers of ongoing trials, including ClinicalTrials.gov, the ISRCTN registry, and the European Clinical Trials Database. At the same time, we handsearched the references quoted in the identified trials, and sought information from researchers, pharmaceutical companies, and relevant trial authors about unpublished or uncompleted trials. We placed no restrictions on language. SELECTION CRITERIA We included all randomised controlled clinical trials (RCTs) evaluating baclofen versus placebo or any other treatment for people with AWS. We excluded uncontrolled, non-randomised, or quasi-randomised trials. We included both parallel group and cross-over studies. DATA COLLECTION AND ANALYSIS Two review authors independently assessed references retrieved for possible inclusion. Any disagreements were resolved by an independent party. We contacted study authors for additional information where needed. We collected adverse effects information from the trials. MAIN RESULTS Two RCTs with a total of 81 participants were eligible according to the inclusion criteria. One study suggested that both baclofen and diazepam significantly decreased the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) score, without any significant difference between the two interventions. The other study showed no significant difference in CIWA-Ar score between baclofen and placebo, but a significantly decreased dependence on high-dose benzodiazepines with baclofen compared to placebo. Only one study reported on the safety of baclofen, without any side effects. AUTHORS' CONCLUSIONS The evidence for recommending baclofen for AWS is insufficient. We therefore need more well-designed RCTs to prove its efficacy and safety.
Collapse
Affiliation(s)
- Jia Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun Street 45, Beijing, China, 100053
| | | |
Collapse
|
33
|
|
34
|
Baclofen-Induced Manic Symptoms: Case Report and Systematic Review. PSYCHOSOMATICS 2014; 55:326-332. [DOI: 10.1016/j.psym.2014.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 01/24/2023]
|
35
|
Rolland B, Paille F, Fleury B, Cottencin O, Benyamina A, Aubin HJ. Off-label baclofen prescribing practices among French alcohol specialists: results of a national online survey. PLoS One 2014; 9:e98062. [PMID: 24887094 PMCID: PMC4041643 DOI: 10.1371/journal.pone.0098062] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/28/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate, among alcohol specialists belonging to the Société Française d'Alcoologie (SFA), i.e., the French Alcohol Society, the proportion of physicians who prescribed off-label baclofen for alcohol use disorders (AUDs). The secondary objective was to depict the features of individual prescribing and monitoring practices. METHODS On-line survey among 484 French alcohol specialists. Physicians were asked whether they prescribed baclofen for AUDs. If they did not, the reasons for this choice were investigated. If they did, the features of the physician's prescribing practice were explored, including the number of patients treated, the mean and maximum doses, the monitoring precautions and the pharmacovigilance reporting. Participants were also asked about their empirical findings on HDB's efficacy and safety. RESULTS In total, 302 physicians (response rate of 62.4%) participated in the survey. Data from 296 participants were analysed, representing 59.4% of all active prescribing physicians belonging to the SFA. HDB use was declared by 74.6% of participants (mean dose 109.5 ± 43.6 mg/d; maximum dose 188 ± 93.3 mg/d). However, 79.2% of prescribers had treated less than 30 patients, and 67.8% used HDB as a second-line medication. Although HDB was perceived as more efficacious than approved drugs by 54.3% of prescribers, it was also declared less safe by 62.8%. Nonetheless, 79.7% of prescribers had never filed any pharmacovigilance report. Non-prescribers (25.6%) were primarily deterred by the current lack of scientific data and official regulation. CONCLUSION A majority of French alcohol specialists reported using HDB, although often on a limited number of their patients. HDB was considered efficacious but also potentially hazardous. Despite this, physicians reported minimal safety data to the health security system. While French health authorities are planning to draft a specific regulatory measure for framing off-label HDB prescribing practices, the sustained education of prescribers on spontaneous pharmacovigilance reporting should be enhanced.
Collapse
Affiliation(s)
- Benjamin Rolland
- Société Française d’Alcoologie, Issy-les-Moulineaux, France
- Service d’Addictologie, CHU Lille, Univ Lille Nord de France, Lille, France
- * E-mail:
| | - François Paille
- Société Française d’Alcoologie, Issy-les-Moulineaux, France
- Service d’Addictologie, CHU Nancy, Université, Univ Nancy, Nancy, France
| | - Benoit Fleury
- Société Française d’Alcoologie, Issy-les-Moulineaux, France
- Service d'Hépatogastroentérologie et d'Alcoologie, CHU Bordeaux, Bordeaux, France
| | - Olivier Cottencin
- Société Française d’Alcoologie, Issy-les-Moulineaux, France
- Service d’Addictologie, CHU Lille, Univ Lille Nord de France, Lille, France
| | - Amine Benyamina
- Société Française d’Alcoologie, Issy-les-Moulineaux, France
- CERTA L’Albatros, Hôpital Paul Brousse, AP-HP, INSERM U 669, Villejuif, France
| | - Henri-Jean Aubin
- Société Française d’Alcoologie, Issy-les-Moulineaux, France
- CERTA L’Albatros, Hôpital Paul Brousse, AP-HP, INSERM U 669, Villejuif, France
| |
Collapse
|
36
|
Kim JH, Lawrence AJ. Drugs currently in Phase II clinical trials for cocaine addiction. Expert Opin Investig Drugs 2014; 23:1105-22. [PMID: 24773297 DOI: 10.1517/13543784.2014.915312] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION There are no FDA-approved pharmacotherapies for treating cocaine addiction; thus, developing drugs to treat cocaine dependence is an unmet critical need. Fortunately, there are a number of drugs that are currently in Phase II clinical trial/s. This is due in part to the advances from in vivo imaging in humans which provided a roadmap of the neurochemistry of the cocaine-dependent brain. Most drugs currently in Phase II clinical trials attempt to modulate the disturbed neurochemistry in cocaine dependents to resemble those of healthy individuals. These predominantly modulate dopamine, serotonin, glutamate, GABA or noradrenaline signalling. AREAS COVERED This review summarizes the therapeutic potential of each drug as evidenced by clinical and preclinical studies. It also discusses their utility in terms of bioavailability and half-life. EXPERT OPINION Amphetamine salts and topiramate clearly stand out in terms of their potential efficacy in treating cocaine addiction. The efficacy of topiramate was closely associated with regular cognitive-behavioural therapy (CBT), which highlights the importance of a combined effort to promote abstinence and enhance retention via CBT. Cognitive/psychological screening appears necessary for a more symptom-based approach with more reasonable outcomes other than abstinence (e.g., improved quality of life) in treating cocaine addiction.
Collapse
Affiliation(s)
- Jee Hyun Kim
- The Florey Institute of Neuroscience and Mental Health, Behavioural Neuroscience Division , Parkville, VIC 3052 , Australia
| | | |
Collapse
|