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Study, Feb/19:Comparison of baclofen & lorazepam in treatment of alc. withdrawal


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The full title of this Indian study is "Comparative efficacy of baclofen and lorazepam in the treatment of alcohol withdrawal syndrome".

 

Check out the amount of lorazepam used in for alcohol withdrawal in this study...8-12 mg/day. Very high. Doesn't this just exchange one type of addiction/dependence for another? I see why the use of a benzo will take away the alcohol withdrawal symptoms, but I don't see how they will help the people to then get off the benzo.

 

https://www.ncbi.nlm.nih.gov/pubmed/30745655 

 

Abstract

 

Background:

 

Benzodiazepines (BDZs) have been the treatment of choice for alcohol withdrawal syndrome (AWS); however, they are associated with several side effects and also have abuse potential. In some studies, the use of baclofen has been effective in reducing symptoms of alcohol withdrawal symptoms.

 

Aim:

 

The objective of this study was to compare the efficacy of baclofen and benzodiazepine (lorazepam) in reducing symptoms of AWS.

 

Materials and Methods:

 

It was a single-center, randomized, open-label study. Patients with alcohol dependence syndrome were enrolled in the study and randomized into two groups using computer-generated random table number. Baclofen (experimental group, 10 mg three times a day) and BZDs (control group, lorazepam, 8-12 mg/day in divided doses) were orally administered for reducing symptoms of alcohol withdrawal. Both groups received Vitamin B1 (100 mg/day through intramuscular route) and psychotherapeutic interventions. The severity of alcohol dependence was assessed by using the Severity of Alcohol Dependence Questionnaire, and alcohol withdrawal was assessed with the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar).

 

Results:

 

Sixty-six patients were randomized (baclofen n = 34, benzodiazepine (BZD) group n = 32). Two patients (one patient in each group) had complicated withdrawal symptoms and were dropped from the final analysis. There was a significant reduction in alcohol withdrawal symptoms in both groups. There were no significant differences in CIWA-Ar scores between the two groups. Both the drugs were well-tolerated.

 

Conclusion:

 

Baclofen and lorazepam are comparable in efficacy and tolerability in reducing symptoms of AWS.

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I think they just use it short-term so not long enough for the person to develop tolerance.  It helps get them through DTs and lowers their risk of death from the alcohol detox.  I think it's an appropriate use of the drug (not sure how much they need to use though, that seems like a lot) and it's pretty remarkable it can be so effective for this.  The real risk then for the alcoholics is to stay away from alcohol (and continued benzo-use) otherwise it might mean less effective treatment with benzos and death the next time.
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Right, I understand why it works (GABAA receptors involved in both alcohol and benzo use), but I'd sure like to understand how they help people transition from alcoholism to 8-12 mg of lorazepam a day to nothing. That last step is missing.
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Right, I understand why it works (GABAA receptors involved in both alcohol and benzo use), but I'd sure like to understand how they help people transition from alcoholism to 8-12 mg of lorazepam a day to nothing. That last step is missing.

 

Why do you think a step is missing?

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How do they get people off 8-12 mg of lorazepam? That's a lot! They're controlling symptoms with the meds, but are they creating another form of dependence?
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How do they get people off 8-12 mg of lorazepam? That's a lot! They're controlling symptoms with the meds, but are they creating another form of dependence?

 

I'm not 100% but I don't think it's a factor.  It's not long enough to create a dependence.  The high amount may be bc their receptors are already damaged from the alcohol and their response wouldn't be enough from a lower dose.

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Geez, I sure hope there's some sort of support or counselling. If there's just alcohol, then benzo, then nothing, isn't a person quite likely to just fall back into old habits, to say nothing of the physical distress they might be in? Obviously, I know very little about this topic, but it seems to me that alcohol addiction is usually a complex problem that necessitates some form of support in order to have a good long-term outcome.
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Geez, I sure hope there's some sort of support or counselling. If there's just alcohol, then benzo, then nothing, isn't a person quite likely to just fall back into old habits, to say nothing of the physical distress they might be in? Obviously, I know very little about this topic, but it seems to me that alcohol addiction is usually a complex problem that necessitates some form of support in order to have a good long-term outcome.

 

28 day inpatient rehab if they’re fortunate (maybe not depending on your perspective?) enough to have good insurance and time and that followed by a 2 week partial hospitalization program or a longer intensive outpatient program if they’re really fortunate. Meds are prescribed and people are expected to follow up with their PCPs after.  It’s similar with all “drugs of abuse” in the US anyway. This is the addiction “treatment” most people get. Many of these places are operating for huge profits and the care is not very effective. Some people have good experiences and go on with outpatient counseling and or AA/support groups for life.

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Ah, I see. Thanks, seltzerer.

 

Sure. If they don’t have insurance or otherwise can’t afford, they’re released into the community with referrals to community based support programs (non-profit, religious-based programs, etc). While going through detox, the hospital will likely eat the cost and offset that with federal subsidies for indigent care. Not having insurance is a huge risk factor. I suppose this happening isn’t so much of a problem in Canada w universal healthcare.

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Yes, I'd have to do research to see what's available, but probably each province has a slightly different options. Health care is a provincially-funded service. I'm sure there are private options too, though.
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How long do they prescribe those doses? This study obviously doesn't address it, but I'm curious. Any idea?

 

It's right there in the full study: :thumbsup:

 

 

DISCUSSION

 

The present study was conducted to evaluate the efficacy of baclofen in the management of AWS against the standard treatment with BZD (lorazepam). Before the initiation of treatment, both the groups had comparable severity of withdrawal symptoms (total as well as individual item-wise score) as measured by CIWA-Ar. The results showed that in both the groups, it was possible to complete the detoxification within 8 days and there was no difference in the total as well as individual item withdrawal scores during the period of 8 days. A similar outcome was reported in an earlier study in which baclofen was compared to diazepam for controlling withdrawal symptoms.[10]

 

-------------------------------

 

Only one patient in the baclofen group (EG) reported sedation which subsided on its own and did not require any dose modification. None of the patients in lorazepam group (CG) reported any side effect.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341928/

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