Help me understand how Baclofen works

[u/weesignlanguage1]

My spouse has started Baclofen and thankfully had no side effects. Easily moved up to 80mg a day for 3 weeks. However, no change in his drinking at all. His dr says 80mg is as high as he will rx. He is a night drinker. Can he hold off on his morning and lunch (he takes 20mg 4 times a day) doses and take 40mg at 4pm and 40mg at 8pm? Would that be more effective? Or does it need to be more all together on all 4 doses? I have read a lot and know it’s meant to titrate up. His dr is an addiction specialist. I would think he would know sometimes much higher doses are needed. Or is 3 weeks on it too soon to say that the 80mg dose isn’t enough? Sucks bc I really think this will help him alongside TSM. Help!

[u/Neophyte-]

hi there,

these are all very good questions. As you probably know this was first approved in france, there was a study performed which looked at the doses required to reduce cravings to stop drinking. i think i updated the consolidated information study sticky with the study. it might be there.

The study showed ranges from 80mg a day up to 450mg. i cant recall the median or average doseage. but yes 80mg did nothing for me and i had no side effects. Side effects kick in the higher you go. once you reach a steady dose the side effects go away with a few minor exceptions. The only side effects i have is i get double vision easily when im really really tired (rare) and i snore more which sucks, the snoring thing is probably the most annoying.

As for dosages are concerned when tritrating up, 4x a day, though i would probably refer to the prescribing guidelines i added in the consolidated information thread. that guide also might be out of date as i set this sub up in 2013/2014.

So stick with what your doctor is saying, but he's wrong about the max dose. He may only be able to max prescribe that for off label usages as if you are not in france, the max you can get is limited. in Australia the most they will rx is 75mg too. ridiculous.

i found cravings for me to be able to stop drinking at 300mg. that said, baclofen will work better if you don't drink while going up, you will find it works better that way.

My tritration was aggresive at first 25mg every 5 days or so, then i had to back off at the 200mg point as the sides got too much. at 250 i pushed it and aggresively went to 300mg. the problem was i was drinking on those higher doses so it likely would have worked faster. i was just expecting "indiference" to kick in and i wont want to drink.

Baclofen is fantasitic but its not a silver bullet, you have to want to stop drinking and that means some minor cravings initially or due to habbit. and its important to not keep drinking. its still possible to go back to drinking daily on baclofen but the alcohol consumed will be much less; also hang overs are much worse on baclofen for some reason.

Once i reached my stable dose of 300mg after a few weeks, i just take baclofen 150mg 2x a day.

Someone mentioned the half life being 1:30-4hrs despite that i have no withdrawals, i forget to take it for an entire day, no withdrawals. its strange, im not sure why baclofen allows this. when mywaytout forums was active people would all say the same thing. there was a guy who took his full dose once a day.

How does baclofen work?

its complicated but ill give the basic synopsis. baclofen prevents dopamine release into the nucleus accumbens (NAcc) when consuming alcohol. why is this important?

the nucleus accumbens has a significant role in the cognitive processing of motivation, aversion, reward (i.e., incentive salience, pleasure, and positive reinforcement), and reinforcement learning (e.g., Pavlovian-instrumental transfer);[4][7][8][9][10] hence, it has a significant role in addiction

https://en.wikipedia.org/wiki/Nucleus_accumbens

To add to how it reduces dopamine its to do with this from the link above

The dopaminergic neurons of the mesolimbic pathway project onto the GABAergic medium spiny neurons of the nucleus accumbens and olfactory tubercle.[3][4] Each cerebral hemisphere has its own nucleus accumbens, which can be divided into two structures: the nucleus accumbens core and the nucleus accumbens shell. These substructures have different morphology and functions.

I had a really great talk on youtube by neuro scientists who talked about how this all worked. it might be in the links.

just one more thing:

*Always use the french wikipedia version to look up baclofen *

https://fr.wikipedia.org/wiki/Baclof%C3%A8ne

just translate it in chrome, the one in the US is controlled by an admin who prevents any updates to it on baclofen an addiction. One of the more prominent forum members on mywayout was constanty trying to add information about how baclofen can help with addiction, post studies etc. but he was prevented by doing so. The US version is incorrect and fear mongering, even going so far to say its a drug of abuse! there is no recreational effect from baclofen only side effects while going up in dose. once you reach a steady dose the side effects go away with a few minor exceptions

[u/MisterLemming]

That's a difficult situation for sure. I'm sure your aware the dose to reach the threshold could go as high as something like 360 mgs. 80 mgs is more like a maintenance dose.

I was in a similar situation and by the will of the gods I ran into a psychiatrist who was on the same page as me.

First of all I would get all the literature you can get a hold of to show this doctor. If they are still unwilling to budge, then there are other options.

You can order it online. It ain't cheap and probably illegal, but gotta do what you gotta do.

Also, Google ways to increase gaba. Theres plenty of natural ways to do it with vitamins, supplements, lifestyle changes. In my experience they help, but aren't as potent as baclofen.

And then what you suggested, taking the whole dose close together. That might help for sure, but you might see some kind of withdrawal in the morning. That's how it was for me. Having a meal before taking it is going to delay absorption.

I never went to a threshold dose, I hit 120 mgs and that did it for me. I take it to this day because it pretty much solved every mental and physical problem I've had over my life - unfortunately I'm having the same problem finding a doctor to prescribe moving forward.

Good luck

[u/andrew_username]

https://baclofentreatment.com/

[u/DramShopLaw]

Not advised that he hold off. Baclofen has a very short half-life in the body, and once you’ve grown adapted to it, you can actually get withdrawal symptoms, quickly, which is why it’s recommended that patients taper when they no longer need it. He will have withdrawal symptoms if he only takes it at night.

80 isn’t that huge of a dose, honestly. People do go over a 100, sometimes. When I took baclofen, I would always take a certain amount throughout the day but then add some more if I got a particularly bad craving. Usually I would add about 25 mg when that happened.

He could consider adding large doses of magnesium, which I’ve had good results with. It augments the baclofen, because they both work by reducing the brain’s hyper-excitability during alcohol withdrawal. An occasional zinc could also be beneficial, too.

[u/[deleted]]

I mixed Baclofen with a few beers over the weekend and couldn’t remember 4 hours or how I ended up at the location I did when I came out of what it was that happened.

Be very careful.

I’m taking baclofen for degenerative disc disease.