A Case of De novo Seizures Following a Probable Interaction of High-Dose Baclofen With Alcohol

Benjamin Rolland; Sylvie Deheul; Thierry Danel; Régis Bordet; Olivier Cottencin

Disclosures

Alcohol Alcohol. 2012;47(5):577-580. 

In This Article

Abstract and Introduction

Abstract

Aims: Baclofen is a promising medication for the treatment of alcohol dependence, and the prescription of high-dose baclofen (HDB) is increasing within the medical community, especially for patients who are unresponsive to approved treatments. Although baclofen is considered to be quite safe at low doses, the possible interactions between HDB and alcohol have not been precisely studied.
Methods: We report the case of a 46-year-old patient without any history of neurological disorders who experienced two episodes of seizures after a short relapse of alcohol misuse while undergoing treatment with up to 240 mg/day of baclofen.
Results: Although both alcohol and baclofen may theoretically induce seizures individually, we discuss and largely rule out the likelihood that either of these two drugs was solely responsible for the patient's seizures. We hypothesize that the seizures resulted from an interaction between alcohol and HDB, and determined that this hypothesis is 'probable' with Horn's Drug Interaction Probability Scale.
Conclusion: We encourage our colleagues who prescribe HDB to acquaint their patients with the possible enhanced risk of seizures, notably in persistence of alcohol abuse. Moreover, until data from a large study on the safety of HDB use by alcohol misusers are available, this treatment should be conducted under strict supervision and after having carefully evaluated the benefit–risk ratio.

Introduction

The gamma-aminobutyric acid B (GABA-B) agonist baclofen has been a long-time approved medication for spasticity. A few years ago, a major publication reported that a 30-mg/day dose of baclofen in subjects with alcoholic liver cirrhosis could significantly reduce the risk of relapse into alcohol-dependence, with a very good safety level (Addolorato et al., 2007). However, a negative result was published soon thereafter (Garbutt et al., 2010). Consequently, the exact efficacy of low doses of baclofen on alcohol misuse is under debate, even if it appears that this molecule is quite safe at low doses (Leggio et al., 2010). In parallel, the off-label use of high-dose baclofen (HDB) to treat heavy drinking has recently increased in the medical community (Pastor et al., 2012; Rigal et al., 2012), and more specifically in France (Rolland et al., 2012). However, the precise safety level of this therapeutic practice is uncertain because it remains unclear whether there are harmful interactions between alcohol and HDB in some patients (Rolland et al., 2012). Baclofen overdose occurs with doses of 200 mg or more, and may induce confusion, coma, delirium and seizures (Leung et al., 2006). In addition, alcohol intoxication can also trigger rather similar complications (Vonghia et al., 2008). Therefore, because there is currently a lack of data on HDB, assessing the point at which the baclofen toxicity spectrum is reached in chronic use is difficult, notably in the persistence of alcohol abuse. It seems necessary that physicians who prescribe HDB carefully supervise their patients and report any adverse event they have encountered with the use of this treatment (Rolland et al., 2012). Our team has set up a system of off-label HDB prescriptions, which provides precise information and increased supervision to the patients (Rolland et al., 2010). We report here the case of a patient that was included in this protocol and experienced two consecutive episodes of seizures after a short relapse of alcohol use. This patient had no previous medical history of epilepsy or convulsions.

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