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Monday, July 9, 2012

A Case of De novo Seizures Following a Probable Interaction of High-Dose Baclofen with Alcohol

Baclofen is a promising medication for the treatment of alcohol dependence, and the prescription of high-dose baclofen (HDB) is increasing within the medical community, especially for patients who are unresponsive to approved treatments. Although baclofen is considered to be quite safe at low doses, the possible interactions between HDB and alcohol have not been precisely studied.

We report the case of a 46-year-old patient without any history of neurological disorders who experienced two episodes of seizures after a short relapse of alcohol misuse while undergoing treatment with up to 240 mg/day of baclofen.

Although both alcohol and baclofen may theoretically induce seizures individually, we discuss and largely rule out the likelihood that either of these two drugs was solely responsible for the patient's seizures. We hypothesize that the seizures resulted from an interaction between alcohol and HDB, and determined that this hypothesis is ‘probable’ with Horn's Drug Interaction Probability Scale.

We encourage our colleagues who prescribe HDB to acquaint their patients with the possible enhanced risk of seizures, notably in persistence of alcohol abuse. Moreover, until data from a large study on the safety of HDB use by alcohol misusers are available, this treatment should be conducted under strict supervision and after having carefully evaluated the benefit–risk ratio.

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