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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]
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2
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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.
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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
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Sastre C, Ameline A, Baillif-Couniou V, Kintz P, Alvarez JC, Gaulier JM, Allorge D, Champeaux-Fesquet C, Pembedjoglou D, Torrents J, Léonetti G, Pélissier-Alicot AL. Concentrations post mortem de baclofène : présentation d’un cas et étude de la littérature. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2018. [DOI: 10.1016/j.toxac.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rolland B, Simon N, Franchitto N. Safety Challenges of Using High Dose Baclofen for Alcohol Use Disorder: A Focused Review. Front Psychiatry 2018; 9:367. [PMID: 30186187 PMCID: PMC6113385 DOI: 10.3389/fpsyt.2018.00367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/24/2018] [Indexed: 01/13/2023] Open
Abstract
Since the early 2000s, the gamma-aminobutyric acid type B (GABA-B) receptor agonist baclofen has been extensively used for treating alcohol use disorder (AUD). In some countries, like France, Australia, or Germany, baclofen has been used at patient-tailored dose regimens, which can reach 300 mgpd or even more in some patients. The GABA-B-related pharmacology of baclofen expose patients to a specific profile of neuropsychiatric adverse drug reactions (ADRs), primarily some frequent sedative symptoms whose risk of occurrence and severity are both related to the absolute baclofen dosing and the kinetics of dose variations. Other frequent neuropsychiatric ADRs can occur, i.e., tinnitus, insomnia, or dizziness. More rarely, other serious ADRs have been reported, like seizures, manic symptoms, or sleep apnea. However, real-life AUD patients are also exposed to other sedative drugs, like alcohol of course, but also benzodiazepines, other drugs of abuse, or other sedative medications. Consequently, the occurrence of neuropsychiatric safety issues in these patients is essentially the result of a complex multifactorial exposure, in which baclofen causality is rarely obvious by itself. As a result, the decision of initiating baclofen, as well as the daily dose management should be patient-tailored, according the medical history but also the immediate clinical situation of the patient. The overall safety profile of baclofen, as well as the clinical context in which baclofen is used, have many similarities with the use of opiate substitution medications for opiate use disorder. This empirical statement has many implications on how baclofen should be managed and dosing should be adjusted. Moreover, this constant patient-tailored adjustment can be difficult to adapt in the design of clinical trials, which may explain inconsistent findings in baclofen-related literature on AUD.
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Affiliation(s)
- 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
| | - Nicolas Simon
- APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Service de Pharmacologie Clinique, CAP-TV, Aix Marseille Univ, Marseille, France
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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.
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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
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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
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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.
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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
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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
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Décès d’une alcoolique chronique par baclofène dans un cadre suicidaire chez un sujet naïf. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2015. [DOI: 10.1016/j.toxac.2015.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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