Baclofen in the treatment of alcohol use disorder: tailored doses matter.

IF 2.1 4区 医学 Q3 SUBSTANCE ABUSE
Renaud de Beaurepaire, Philippe Jaury
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Abstract

Aims: To address the question of tailored baclofen prescribing in alcohol use disorder (AUD) in relation to dose-dependent efficacy and the potential danger of high doses and to provide suggestions for the use of high doses of baclofen in the treatment of AUD. The context is the approvement in France of baclofen in the treatment of AUD without dose limitation, making French physicians, who usually prescribe baclofen in a tailored manner, often use high or very high doses.

Methods: A narrative review of the results of randomized controlled trials (RCTs) and observational studies that used tailored baclofen prescribing and of the severe adverse effects of baclofen that have been reported in the literature.

Results: The results show that RCTs using tailored doses of baclofen in AUD are not completely demonstrative, though they are encouraging according to certain meta-analyses, while observational studies that used tailored doses constantly show a good effectiveness of baclofen treatment. The results suggest that many severe adverse effects of baclofen could be related to a nonrespect by physicians of prescription rules and appropriate treatment monitoring.

Conclusions: The use of tailored doses shows that the dose required to suppress cravings is highly variable, low or high, depending on each case. Analysis of the circumstances in which severe adverse effects occur suggest that a careful monitoring of baclofen prescribing might prevent a large majority of severe adverse effects. We propose that the education of the patients and the prescription skills, seriousness, and availability of the prescribing physicians are of major importance in the managing of tailored baclofen treatment of AUD.

巴氯芬治疗酒精使用障碍:量身定制的剂量很重要。
目的:探讨针对酒精使用障碍(AUD)的巴氯芬处方与剂量依赖性疗效和大剂量潜在危险的关系,并为使用大剂量巴氯芬治疗AUD提供建议。背景是法国批准巴氯芬用于治疗AUD,且无剂量限制,这使得法国医生通常根据具体情况开具巴氯芬处方,但却经常使用大剂量或超大剂量:方法:对使用定制巴氯芬处方的随机对照试验(RCT)和观察性研究的结果,以及文献中报道的巴氯芬的严重不良反应进行叙述性综述:结果:研究结果表明,在AUD中使用定制剂量巴氯芬的随机对照研究虽然根据某些荟萃分析结果令人鼓舞,但并不完全具有示范意义,而使用定制剂量的观察性研究则不断显示出巴氯芬治疗的良好疗效。研究结果表明,巴氯芬的许多严重不良反应可能与医生不遵守处方规则和适当的治疗监测有关:使用定制剂量表明,抑制渴求所需的剂量变化很大,或低或高,取决于每种情况。对严重不良反应发生情况的分析表明,对巴氯芬处方进行仔细监测可避免大部分严重不良反应的发生。我们建议,对患者的教育以及处方医生的处方技能、严肃性和可用性,对于管理巴氯芬治疗 AUD 的定制治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Alcohol and alcoholism
Alcohol and alcoholism 医学-药物滥用
CiteScore
4.70
自引率
3.60%
发文量
62
审稿时长
4-8 weeks
期刊介绍: About the Journal Alcohol and Alcoholism publishes papers on the biomedical, psychological, and sociological aspects of alcoholism and alcohol research, provided that they make a new and significant contribution to knowledge in the field. Papers include new results obtained experimentally, descriptions of new experimental (including clinical) methods of importance to the field of alcohol research and treatment, or new interpretations of existing results. Theoretical contributions are considered equally with papers dealing with experimental work provided that such theoretical contributions are not of a largely speculative or philosophical nature.
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