Medication Reference Card: Alcohol Use Disorder

Baclofen

5–10 mg TDS titrating to 30–80 mg/day · Renally cleared, hepatically safe · Off-label (AUD)

Dr Basanth Kenchaiah
FRANZCP · Cert. Addiction Psych. · MBBS · DPM · DNB (Psychiatry) Addiction Psychiatrist v1.3 · October 2026

Audience Clinicians

Purpose Prescribing quick-reference for baclofen in alcohol use disorder (AUD).

Key messages

GABA-B agonist: reduces craving, anxiety and withdrawal; off-label for AUD in Australia; document clinical reasoning
Start 5–10 mg TDS; titrate slowly to 30–80 mg/day; particularly effective when comorbid anxiety drives drinking
Renally cleared: safe in liver disease; reduce dose in renal impairment; monitor sedation and overdose risk

For Patients

Baclofen is a muscle-relaxant medication that also reduces the desire to drink alcohol. It can be used even in people with liver disease, which makes it different from many other treatments. It is used off-label for alcohol use disorder in Australia, and your doctor will discuss whether it is appropriate for you.

Particularly useful when comorbid with:

Hepatic cirrhosis / significant liver disease (renally cleared) Anxiety disorders (anxiolytic properties) Failed naltrexone or acamprosate Nicotine dependence (modest evidence) Chronic pain with muscle spasm (dual benefit)

For Clinicians

Mechanism

GABA-B receptor agonist acting centrally to reduce mesocortical dopamine activity and dampen the reward response to alcohol. Also reduces anxiety via GABA-B activation (clinically useful anxiolytic effect). Unlike most pharmacotherapy agents, baclofen is renally excreted and does not require hepatic metabolism.

Dosing

Start: 5–10 mg TDS. Titrate: increase by 10 mg/week to target 30–80 mg/day. Cirrhosis / severe AUD: cautious titration to 30–60 mg/day. French protocols use up to 300 mg/day (Baclofène, not routine in Australia). Off-label for AUD in Australia. Document clinical reasoning and obtain informed consent.

Evidence

BACLOVILLE RCT (Rigal et al. 2020; 320 patients in primary care, 12 months, baclofen titrated up to 300 mg/day): baclofen was more effective than placebo for the primary outcome of no or low-risk drinking (57% vs 36%), but the difference was not significant when patients who switched to open-label baclofen were not counted as failures (62% vs 55%); adverse events and serious adverse events were more frequent with baclofen. Cochrane review (Minozzi et al. 2018; 12 RCTs, 1,128 participants): no difference between baclofen and placebo on its primary or secondary outcomes, and the evidence remains uncertain for first-line use. Particularly valuable where standard agents are contraindicated (e.g. significant hepatic disease).

Cautions

Sedation and dizziness, especially at initiation: counsel on driving
Sudden withdrawal can cause seizures: taper slowly if discontinuing
Avoid in severe renal impairment (CrCl <30 mL/min): dose accumulates
Additive CNS depression with benzodiazepines and alcohol
Psychiatric side effects at high doses (hallucinations, confusion): monitor
Use with caution in epilepsy: specialist advice recommended