Medication Reference Card — Alcohol Use Disorder
5–10 mg TDS titrating to 30–80 mg/day · Renally cleared — hepatically safe · Off-label (AUD)
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.
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.
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.
BACLOVILLE RCT (Rigal et al. 2012): baclofen 30–150 mg/day significantly increased abstinence vs placebo in AUD. Cochrane review 2018: moderate evidence for reduced drinking. BnB trial (Australia, Morley et al.): comparable to naltrexone in reducing heavy drinking. Particularly valuable where standard agents are contraindicated (e.g. significant hepatic disease).