Is baclofen's short duration of action a serious problem?

[Greg]

I have found a doctor willing to prescribe me baclofen at a high dose (up to 100-200 mg per day), but I am very worried after reading some of the side-effects mentioned by people here and also benzodiazepine-type withdrawal symptoms I've read elsewhere. ANYTHING is better than continuing to drink, so I am going ahead with the baclofen, but not until I am detoxed from alcohol (AGAIN!) so I am not mixing baclofen with alcohol.

Anyway, what worries me the most is baclofen's very short half-life, which I have read as being somewhere between 2 and 5 hours when it is taken orally. I read another article stating it has an average half-life of 3-4 hours. This means it is a VERY short-acting drug, which I think could be a real problem for any medication that is a GABA agonist/general CNS depressant.

Because I only drink at night, and have no alcohol cravings during the day, I had planned to use baclofen only at night rather than spreading it out over a 24-hour period like most people seem to do. Due to severe insomnia I always experience during periods of sobriety, I was also hoping this once-a-night dosage would allow me a good night's sleep and the avoidance of daytime sedation. After reading of baclofen's very short duration of action (i.e. short half-life) I now wonder if it's possible to take it the entire daily dose at night without experiencing severe withdrawal symptoms during the following day?? I'm not a wimp but I'd sure like to hear if anyone else has used it this way without problems. Maybe most of the daily dose could still be taken shortly before bedtime to help with cravings and insomnia, with a smaller amount taken during the daytime to help avoid withdrawals and serious side-effects. I have noticed other members experiencing side-effects, including sleep problems, and I wonder if some of these may also be due to baclofen's very short duration of action and therefore changes from sedation to mild hyperactivity within a fairly short period of time.

Please don't think I'm putting baclofen down or trying to say it's not a great treatment for alcoholism. I'm just a fairly desperate alcoholic who has tried all the other treatments and needs to quickly stop drinking due to the effects on my health of regularly drinking the equivalent of a bottle of spirits every night. I already know about The Sinclair Method but cannot do it at the moment since I would have to keep drinking at very high levels for many months for it to become effective for me. I have Dr. Amiesen's book but the issue of baclofen's very short duration of action and possible withdrawal issues don't seem to be mentioned.

Best wishes to all, and sorry if this issue has already been covered elsewhere on the forum.

[billyb]

Is baclofen's short duration of action a serious problem?

Just to be clear - you and your doctor are aware that you will need to start at a low dose, and then slowly increase before getting to that 100-200mg level, correct?

Anyways, the half-life is short, and you might feel some minor withdrawal symptoms if you go for 12 hours or so without a dose (I've felt a little nervousness, a bit "on edge" feeling, and even a little bit of spaciness when I forget to take a dose or two). But serious withdrawal, if you get it, usually happens around 24-72 after the last dose, according to most of the literature. Keep in mind that just because the half-life is short doesn't mean that the duration of effect is the same length - they are not necessarily the same thing, since there's a whole lot of complexity in how your body absorbs and metabolizes drugs.

I don't know any of the details about how baclofen is metabolized, but from my own experience I generally feel it start to work after about 20-30 minutes, I feel a peak in its effect about 2 hours in, which then tapers down slowly over the next 4-6 hours. So, I usually still feel the effects of last night's dose when I wake up in the morning.

I take 10mg in the morning, 10mg around lunch, and then space out the remaining 80mg from about 3pm to 9pm, usually 30-30-20 at about 3pm, 6pm, 9pm. Taking those last doses close to each other achieves the kind of effect you seem to anticipate needing - getting rid of the evening cravings and helping me get to sleep.

You will almost certainly feel daytime drowsiness while slowly increasing your dose. It's pretty much unavoidable, although lots of coffee helps. Once your reach your maintenance dose and begin to titrate down, though, the side effects will get a whole lot better. I don't notice anything from the 10mg doses, and the larger doses in the evening only give me a very mild feeling of relaxation.

[tiptronic_ct]

Is baclofen's short duration of action a serious problem?

Hey, Greg

I'm one of the wimps who maintains a level of baclofen in my system throughout the day because of the fear of WD.

Having said that, I am reconsidering. I also used to be a nighttime drinker. At the moment, I take 10mg early morning, 20mg around lunchtime, 60mg around 16h00 & 50mg around 20h00.

WD is a POTENTIAL side-effect of discontinuing bac suddenly or taking it sporadically. I think it was Beatle who pointed out that not all Alcoholics suffer from WD when going cold turkey, despite being heavy drinkers. The same principle applies.

I'd play it safe if I were you, by initially spreading out the doses more evenly as you titrate up, then gradually shifting towards afternoon & evening once you've reached the point of indifference. Just try and keep track of how you're feeling, and have enough bac on your person at all times should you feel anything untoward...

I hope that helps. Please shout if I should clarify anything further.

There a re a number of members here who take bac as you intend to. I'm sure they'll give advice as well.

[bernard]

Is baclofen's short duration of action a serious problem?

Alcohol's actions on the body (and mind) are well correlated to its concentration in the body. But there are many drugs for which this is not the case, and baclofen seems to be one of them. As tip and beatle said, the 2-3 hours is when the blood concentration goes down to half of its peak value. Drugs that need to be kept at more constant levels require other methods of delivery, such as extended release packaging or intravenous drip. (This latter term is where the expression for needy lovers came from, as in "The guy is so clingy, he needs an IV drip.")

[panda farts]

Is baclofen's short duration of action a serious problem?

I don't think you can take it all in one dose before bed... (I take 150mg a day and can't imagine taking it all at once)

but you can load up late in the day.. I found that when I took doses spread out across the entire day I was sleepy at work and since my cravings were like yours (only in the evening) I started taking:

50mg @ 2
50mg @ 6
50mg @ 8

and that takes care of my craving and minimizes my side effects.. though at this point I have no side effects that bother me in any way.

[beatle]

Is baclofen's short duration of action a serious problem?

I agree with all that is said here, and just wanted to add that many people do not have somnolence problems with bac by just making the evening doses a little heavier, and the daytime doses lighter. I have had lots of uncomfortable (not unbearable) side effects with bac, even while titrating up very slowly, but I have never had any problem with somnolence during the day and no problem sleeping at night (after a life of chronic, severe insomnia).

As the others say, it is very unlikely you will experience any kind of withdrawal from not taking it for a few hours, even 12. But remember, if you make sure you have bac with you all the time, you can just take it if you feel like you are experiencing withdrawal symptoms. It's an antidote!

[Greg]

Is baclofen's short duration of action a serious problem?

Many thanks for your replies, which have put me more at ease. I guess one of the main reasons I asked this question was because alcohol itself is a very short-acting sedative drug, and I drink my entire daily amount (20 standard drinks) at night over about 4-5 hours. The next day I get very noticeable withdrawals, including high blood pressure, extreme ringing in the ears, and a pressure-like headache. I used a portable blood pressure machine recently which showed that my BP was restored to normal levels once I had a high level of alcohol in my system.

Thanks billyb yes I realise that baclofen must be tapered upwards and not just suddenly taken at a high daily dose. My doctor has very limited experience with the drug and has only agreed to prescribe it because all other things I have tried have failed. He knows he is sticking his neck out for me, and I have assured him that I will act responsibly. There is simply no established medical protocol for taking high doses of baclofen as a maintenance/anti-craving drug for alcoholism at the current time, but my doctor is very aware of the potential for withdrawal symptoms. We are going to work closely and I agreed to keep a detailed diary. In my country, oral baclofen is not supposed to be taken at a daily dose higher than 75-80 mg, for any reason.

[Bill.P.]

Is baclofen's short duration of action a serious problem?

Greg, glad to hear you are in the position you are in with getting the baclofen you need> I remember talkign with you about it six months ago.

As far as the blood pressure is concerned. Its a body chemistry issue with alcohol and blood presssure. Alcohol volume depletes your hydraulic system. Less fluid in the system. Lower overall blood pressure.
As a result. your body, particularly your kidneys will vasoconstrict and try to raise your blood pressure by decreasing space for the fluid volume in your body. Then, most alcoholics I know, rehydrate alot and drink water etc.... This fluid goes into the hydraulic system (which is now vasoconstricted due to the dehydration) and voila. high blood pressure.
Once you drink alcohol. you start to urinate, fluid out of the system as well as naturally vasodilating the arteries and normalizing your blood pressure.

Its quite simple really and has to arterial muscle tone and subsequent restriction. A simple ace inhibitor will fix that up easily and once alcohol is not messing up your fluid volume of the body and vascular system. Your blood pressure will not be up and down like it is.
Baclofen also helps with withdrawal.

I wouldnt start a blood pressure medication though until you see where it truly lies without the constant futzing it up with the alcohol. If you purposely wanted to make your blood pressure jump around. Drinking is a great way to do it.
Easily fixed though

Also med half time is not the be all end all of medication effectiveness. Take ibuprofen for example. Short half life, longer effective dose. The half life is 1.5 to 2 hours but duration of effectiveness for pain is up to 8 hours. sure it plays a part, but not much of a concern.
A morning dose and night time dose is needed and either 1 or 2 doses in between during the day is all that is needed. Dont overthink things. And maintaining proper blood levels with even dosages is recommended to start

[Greg]

Is baclofen's short duration of action a serious problem?

Hi Bill P, yes I remember us talking earlier in the year, and recall you being very supportive of me taking baclofen due to your own extremely positive experience. I have kept that in mind, since it was a motivation to keep on searching for a doctor. I had considered the online ordering option but I was too concerned about supplies running low or being blocked by customs, even though I think it was you who said I should have no problems with customs. I didn't want to find myself on a high dose and suddenly without any left. Detox clinics, as far as I know, do not treat withdrawals from drugs that aren't known addictive substances.

Thanks for the blood pressure advice. It's been high at times for a couple of years now, but the ringing in the ears and headaches associated with the high BP have only been noticeable for a few months. I agree with you about not taking any BP medication until after the alcohol is out of my system for good, and my doctor is of the same view. Hopefully it may return to acceptable levels once the daily cycle of intoxication-sobering up-going into mild withdrawals has ended. I should be able to get into the detox clinic in the next week or two, and upon discharge I will begin the baclofen. Thanks also for the explanation of half-life versus effective time. One or two others also pointed this out.

[Greg]

Is baclofen's short duration of action a serious problem?

P.S. Bill, one more question (I meant to include it in my above reply). Have you heard of baclofen being used for sudden withdrawal from alcohol after daily intake in the amount I drink (i.e. 20 standard drinks, which is about equal to a bottle of spirits a day)? I know it has been used at low doses (eg. 10-30 mg) for mild-moderate alcohol withdrawal, and I have seriously considered just stopping drinking and starting baclofen at the time I would normally start drinking again, increasing the dose as required if withdrawals become more severe. I have detoxed from alcohol as an outpatient previously and during that time I was required to take diazepam as indicated by an Alcohol Withdrawal Symptom chart (measuring my own temperature, sweating, tremors, anxiety, agitation, etc.). This would avoid having to wait for the upcoming inpatient detox bed to become available and would get me onto baclofen straight away. My only worry is that I have heard that baclofen isn't as effective at preventing seizures as the benzodiazepines, and if I stuffed up and ended up in an emergency room, my doctor would probably no longer trust me if he found out about it.

[Bill.P.]

Is baclofen's short duration of action a serious problem?

Well Greg,
Again, I hope to visit your area and have you put me up for a night lol.
But in all seriousness, I dont have the studies at my fingertips to point to baclofen withdrawing of alcohol. Although I have read them.
BUT it makes sense, look the withdrawal from alcohol is a benzodiazepine, the withdrawal from baclofen is a benzodiazepine. The withdrawal from a gaba receptor blocker is another gaba receptor blocker.
You do the math.
My understanding is that basically alcohol, benzos and baclofen are alll interchangeable as far as withdrawal.
So I could substitue baclofen or valium with alcohol and conversely as I posted, if you find yourself without your baclofen you can just drink a drink.
Its all gaba system withdrawal.
Baclofen is not addictive while valium and alcohol are on the reward system of the brain. But when it comes to the exact same mechanism of withdrawal. Any one of the 3 will fix it. Just interchange one with the other.
No bac. take valium, no valijm, drink alcohol equals no withdrawal.

No alcohol, take valium etc.., or take baclofen.

Works the same on the gaba. Get my drift?

Each is a square peg for a square hole. All turn the key.
NOW GREG, get your ass sober for fucksake! Jesus Christ. We PMd almost 9 monthis ago you shit!
Look how much time you wasted dithering!

Now do IT

[beatle]

Is baclofen's short duration of action a serious problem?

Bill. P., I hadn't quite worked it out that way, but that's how I've been thinking. It's all GABA and the baclofen is the least harmful.

I have tried withdrawal in many ways, and the method of decreasing doses of alcohol-- it really works (in terms of limited withdrawal discomfort). But during detox, if you can get your hands on more alcohol, you will (we all know it). So it only works in a closed (controlled) environment. Why can't the detox centres figure this out? Slow, controlled reduction of alcohol works. What is all this "cold-turkey or nothing" shit?

[tiptronic_ct]

Is baclofen's short duration of action a serious problem?

Bill.P.;756819 wrote: We PMd almost 9 monthis ago

And would do it more often if you cleaned out your mailbox

[Guest]

Is baclofen's short duration of action a serious problem?

article on the efficay of baclofen compared to benzos for alcohol withdrawl syndrome
Elsevier

[Greg]

Is baclofen's short duration of action a serious problem?

Bill P,

I have always been polite on this site, and I have always been respectful to others. Now I find you calling me a "shit". You once said you wanted to set up a website to gather information about baclofen. Well, mate, when I am clear of alcohol by detoxifying myself and then staying sober by using baclofen, I will not be sharing anything with you due to your extremely disrespectful way of replying to messages. If I didn't care about giving up drinking, would I even bother to post any messages on a site like this? Why would I go out of my way to see a doctor who was willing to prescribe baclofen? Why would I be trying to get into an inpatient alcohol detox clinic, or asking you how I could use baclofen for detox from alcohol?

Mate, if you want to help people, then stop being so rude and abusive when you reply. Calling someone (me) a "shit" isn't exactly a way of reaching out. Even if it's AA-style tough love you are trying, outright abuse isn't a normal AA method of helping people. You seem to know your facts about GABA agonists and their ability to substitute for each other, but there are still a few things you could learn about human relations and the ability to put forward your facts in a tactful and respectful manner.