Off-Label Baclofen Use in Tardive Dyskinesia and Alcohol Dependence

This poster was presented at the 30th annual  Psych Congress, held Sept. 16-19, 2017, in New Orleans, Louisiana.

Baclofen, a selective GABAB receptor agonist, has been used in the treatment of neurological disorders with spasticity since the late 1960's.

METHODOLOGY. Three patients with truncal tardive dystonia and five patients with choreoathetoid tardive dyskinesias of the mouth, face and extremities were treated with baclofen. Psychopathology was evaluated by the BPRS and the movement disorder was assessed by the Simpson Rating Scale. We have also reviewed the literature on baclofen therapy for alcohol dependence.

RESULTS/DISCUSSION. Treatment with baclofen resulted in significant improvement of the movement disorder in the three tardive dystonia patients but no therapeutic effects were observed in the five patients with choreoathetoid dyskinesias. Baclofen administration led to worsening of the psychopathology, one patient developing acute mania while others developed manic symptoms leading to discontinuation of the drug.

In recent years, treatment of alcohol dependence with baclofen in France led to reports of new cases of drug-induced mania and manic symptoms prompting suggestions that this drug might have antidepressant properties. There are conflicting results on the efficacy of baclofen in the treatment of alcohol dependence, and although no serious adverse effects have been noted in clinical trials, in general practice this drug presents major safety concerns. These are related to intentional or accidental intoxications of baclofen alone, or in combination with alcohol or other drugs that may lead to severe toxic syndromes with coma, respiratory depression and in some cases even death. French authorities (Pelissier et al, 2017) recently modified the TRUs (temporary recommendations for baclofen use), noting that this drug is a "second line" treatment, and emphasize the need for regular consultations when baclofen dosages are changed. Braillon and Naudet (2017) view the baclofen saga as "from miracle to mirage"; however, baclofen continues to elicit interest in the scientific community.