title: Assessing alcohol versus baclofen withdrawal syndrome in patients treated with baclofen for alcohol use disorder.
abstract: Baclofen is a γ-aminobutyric acid B (GABA-B) receptor agonist that is approved for spasticity. Recently, the off-label use of baclofen for alcohol use disorder (AUD) has increased. However, baclofen is known to induce a neuroadaptation process, which may be identified by the occurrence of a specific baclofen withdrawal syndrome (BWS), that is, confusion, agitation, seizures, and delirium. The same set of symptoms characterizes alcohol withdrawal syndrome (AWS), which could lead to mistaking BWS for AWS in some situations. We report the cases of 3 patients under a chronic baclofen treatment for AUD. The patients emergently presented with a clinical state of confusion that was initially diagnosed and treated as AWS, with limited effect of benzodiazepines. Retrospectively, using a validated algorithm for assessing drug-induced withdrawal, we determined that all of these clinical cases were consistent with BWS. Both AWS and BWS should be considered in the case of acute confusion or delirium occurring in patients treated with baclofen for AUD. Moreover, further research should investigate to what extent GABA-A and GABA-B induce shared or distinct neuroadaptation processes and withdrawal syndromes.
authors.affiliation: From the *PRES Nord de France, Univ Lille Nord de France; and Departmentsof †Psychiatry and Addiction Medicine, ‡Pharmacology and Pharmacovigilance, and §Resuscitation Care, CHU Lille, Lille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rolland
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Jaillette
authors.forename: Louise
authors.initials: L
authors.lastname: Carton
authors.forename: Camille
authors.initials: C
authors.lastname: Bence
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deheul
authors.forename: Fabienne
authors.initials: F
authors.lastname: Saulnier
authors.forename: Régis
authors.initials: R
authors.lastname: Bordet
authors.forename: Olivier
authors.initials: O
authors.lastname: Cottencin
mesh_terms: D000328:Adult; D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000517:prevention & control*; D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001418:Baclofen / Q000009:adverse effects*; D003221:Confusion / Q000139:chemically induced; D003693:Delirium / Q000139:chemically induced; D003937:Diagnosis, Differential; D058786:GABA-B Receptor Agonists / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use; D011237:Predictive Value of Tests; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology
chemical_list: D058786:GABA-B Receptor Agonists; D001418:Baclofen