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Can You Safely Mix Baclofen and Alcohol?

Known by its Canadian brand name, Lioresal, Baclofen is used primarily to treat symptoms associated with spinal cord disease or injury. It releases tension associated with muscle spasm, cramping and muscle tightness caused by an injury sustained to the spine by working directly with the central nervous system, which may also explain some of its side effects. While baclofen is not a cure-all, it can supplement other modalities such as physical therapy to help treat multiple sclerosis or other spine injuries.

Baclofen is also known to manage other conditions associated with alcohol, opioid, cocaine, and tobacco abuse-related symptoms.  Baclofen is a highly used drug for treating chemical processes in other medications and substances including alcohol, which is why baclofen is used in alcohol and drug addiction. At the same time, lack of data confirms the experimental nature of this drug – specifically in the treatment of alcoholic addiction. 

How Baclofen Works in the Brain

Baclofen activates GABA, a brain neurotransmitter, and relaxes brain activity reducing and minimizing one’s craving for alcohol along with dopamine levels. Baclofen works by blocking reflexes so excitatory transmitters cannot be released. It acts on spinal cord nerves and decreases severe muscle spasms that are caused by multiple sclerosis or spinal cord disease. Over time, it improves muscle coordination and movement and also acts as a muscle pain reliever.

Baclofen and Its Effects on Drugs

As an antispastic muscle relaxant, baclofen blocks nerve signals from muscles at the level of the spinal cord while depressing the central nervous system. Conversely, other drugs such as alcohol, sleeping pills, tranquilizers, muscle relaxants, and vitamins may exacerbate the side effects of baclofen. Alcohol especially may intensify side effects such as drowsiness and dizziness. If you suffer from muscle stiffness, baclofen may cause extreme weakness and imbalance.

Baclofen Drug Interactions

The chemical compounding of baclofen with other drugs has been known to increase side effects in the following:

  • Cardiovascular side effects including increased heart rate, chest pain, and blood changes. This is evident in the most frequent and common baclofen drug interactions including Adderal (amphetamine/dextroamphetamine). You might experience severe or frequent headaches, chest pain, and/or a fast or pounding heartbeat.
  • Other side effects such as dizziness, drowsiness, confusion, and difficulty concentrating as evident in Zolpidem, Benadryl, Cymbalta, Cyclobenzaprine, Gabapentin, Clonazepam, Pregabalin.
  • Central nervous system depression including respiratory distress, coma, and even death used in narcotic pain or cough medications such as hydrocodone, methadone, Norco (acetaminophen/hydrocodone), oxycodone.

While certain medications should not be combined, in some cases your doctor might recommend the combination of two different medicines despite a drug interaction. This partial list of drug interactions may have a significant impact on baclofen, and if any of the ones on this list are prescribed with baclofen, your doctor might adjust the dose or the frequency of use of either of the medications.

  • Alfentanil
  •  Amifampridine
  • Benzhydrocodone
  •  Bromazepam
  • Buprenorphine
  •  Butorphanol
  • Clobazam
  •  Codeine
  • Dihydrocodeine
  • Donepezil
  •  Doxylamine
  •  Fentanyl
  • Flibanserin
  • Hydrocodone
  • Hydromorphone
  •  Levorphanol
  • Lofexidine
  •  Loxapine
  • Meperidine
  • Methadone
  • Metoclopramide
  • Midazolam
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Oxycodone
  • Oxymorphone
  • Pentazocine
  • Periciazine
  • Remifentanil
  • Sodium Oxybate
  • Sufentanil
  • Tapentadol
  • Tramadol
  • Zolpidem

All in all, a total of 763 drugs may interact with baclofen.

Baclofen and Alcohol Interaction

Only three medications (disulfiram, naltrexone, and acamprosate) have been currently approved by the U.S. Food and Drug Administration (FDA) for treating alcoholism dependence. 

This is despite the crippling impact of the disease of alcoholism on society, and specifically in the United States, with over 800,000 receiving treatment for alcohol abuse or dependence.

Alcohol can increase the nervous system side effects from baclofen such as dizziness, drowsiness, and difficulty focusing. You may have also experienced impairment in thinking and judgment. Experts recommend avoiding altogether or limiting the use of alcohol while being treated with baclofen.

While research has given users of alcohol abuse disorder hope that baclofen, a muscle relaxer, and an antispastic agent, can reduce harmful effects, mixing any drug with alcohol can create what is known as pharmacodynamic interaction. Alcohol Research and Health defines this as an interaction “in which alcohol enhances the effects of the medication particularly in the central nervous system.”

There is limited conclusive evidence that shows that in combination with alcohol, no adverse effects in severe alcoholics were reported despite modest increases in heart rate and blood pressure. On the other hand, it has been known to increase sedation and impair cognitive performance significantly. Baclofen did not alter alcohol craving or alcohol-induced subjective effects.

What is a Safe Amount of Baclofen Treatment in Alcohol Addiction?

Baclofen is the only effectively prescribed medication that is widely used for alcohol relapse prevention. It reduces your compulsion to drink to the point that you become indifferent to alcohol while reducing anxiety. In this situation, you do not need to detoxify to begin a baclofen treatment. Once the cravings cease completely, your alcohol intake will dissipate. For Baclofen to be effective in managing alcohol treatment, it needs to be administered at high or very high doses. Concluding evidence shows that in well-supervised medical situations, the amount – low or high – does not seem to impact side effects. Baclofen’s anxiolytic effect starts kicking in at low doses helping curb anxiety related cravings for alcohol.

Baclofen is relatively well tolerated and safe when prescribed in conjunction with high doses of alcohol.

How to Use Baclofen Safely During Alcoholism Abuse Treatment

The key is to maintain a steady alcohol intake. This patient information sheet and initiation regime give you an example of how to keep your alcohol intake stable while monitoring the effect on alcohol cravings and intake as you increase the baclofen dose.  As you up the dose of baclofen, your alcohol intake generally will drop steadily without the need for withdrawal or relapse.

If that your alcohol intake drops too low, baclofen will reduce the intensity of alcohol withdrawal symptoms. If these symptoms do however appear, you might need to take an extra dose of baclofen to compensate or slow down the alcohol reduction. Your pattern of cravings and alcohol intake will determine how to adjust your baclofen dose.

There are situations however when a frail and elderly patient is better off detoxing in a supervised inpatient setting. Ideally, baclofen should be administered in detox and then adjusted up in an outpatient setting. Other alcohol withdrawal situations might be mild enough to be managed in an outpatient setting in which baclofen assisted alcohol withdrawal treatment might be appropriate.

Sources

Nih.gov. [2009]. Acute Interaction of Baclofen in Combination with Alcohol in Heavy Social Drinkers. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626149/#R66

Nih.gov. [1999]. Alcohol and Medication Interactions. from https://www.ncbi.nlm.nih.gov/pubmed/10890797

Baclofen Treatment for Alcoholism. from https://baclofentreatment.com/resources-for-practitioners/

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