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Abstract

We appreciate the interest of Saitz in our work. Although performed in a small group of patients, our comparative study showed that baclofen is comparable to the gold standard diazepam in the treatment of the uncomplicated form of alcohol withdrawal syndrome (AWS), because the Clinical Institute Withdrawal Assessment score decreased in baclofen- and diazepam-treated patients without differences between groups.1Addolorato G. Leggio L. Abenavoli L. et al.Baclofen in the treatment of alcohol withdrawal syndrome: a comparative study vs. diazepam.Am J Med. 2006; 119 (e13-18): 276Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar A slightly slower effect of baclofen was found in only 1 of the AWS symptoms (agitation). Among baclofen-treated patients, no seizures or delirium was noted during treatment or when the course of therapy was finished and in the subsequent follow-up. This might be consistent with the case of suppression of alcohol delirium tremens by baclofen administration recently described.2Addolorato G. Leggio L. Abenavoli L. et al.Suppression of alcohol delirium tremens by baclofen administration: a case report.Clin Neuropharmacol. 2003; 26: 258-262Crossref PubMed Scopus (56) Google Scholar Moreover, baclofen presented no relevant side effects in patients treated for alcoholism,1Addolorato G. Leggio L. Abenavoli L. et al.Baclofen in the treatment of alcohol withdrawal syndrome: a comparative study vs. diazepam.Am J Med. 2006; 119 (e13-18): 276Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar, 2Addolorato G. Leggio L. Abenavoli L. et al.Suppression of alcohol delirium tremens by baclofen administration: a case report.Clin Neuropharmacol. 2003; 26: 258-262Crossref PubMed Scopus (56) Google Scholar, 3Addolorato G. Caputo F. Capristo E. et al.Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study.Alcohol Alcohol. 2002; 37: 504-508Crossref PubMed Scopus (419) Google Scholar, 4Flannery B.A. Garbutt J.C. Cody M.W. et al.Baclofen for alcohol dependence: a preliminary open-label study.Alcohol Clin Exp Res. 2004; 28: 1517-1523Crossref PubMed Scopus (138) Google Scholar, 5Johnson B.A. Swift R.M. Addolorato G. et al.Safety and efficacy of GABAergic medications for treating alcoholism.Alcohol Clin Exp Res. 2005; 29: 248-254Crossref PubMed Scopus (58) Google Scholar whereas the use of benzodiazepines is associated with several side effects, such as the risk of excess sedation and respiratory depression in patients with liver impairment, as is often the case in alcohol-dependent persons.6Mayo-Smith M.F. Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline: American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal.JAMA. 1997; 278: 144-151Crossref PubMed Google Scholar Finally, it should be stressed that baclofen showed its efficacy in reducing alcohol craving and intake in the long-term treatment of alcohol-dependent patients.3Addolorato G. Caputo F. Capristo E. et al.Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study.Alcohol Alcohol. 2002; 37: 504-508Crossref PubMed Scopus (419) Google Scholar, 4Flannery B.A. Garbutt J.C. Cody M.W. et al.Baclofen for alcohol dependence: a preliminary open-label study.Alcohol Clin Exp Res. 2004; 28: 1517-1523Crossref PubMed Scopus (138) Google Scholar This suggests a potential use of this drug as a promising and unique pharmacotherapy for alcohol dependence, from AWS to relapse prevention treatment. These effects should theoretically result in a simplified pharmacotherapy for patients with alcohol problems, increasing the compliance to treatment. Obviously, further studies on a larger sample of patients are required to confirm our data and to evaluate the baclofen effect on AWS complication. However, at present baclofen represents a promising medication for treating alcoholism and merits further investigation.7National Institute on Alcohol Abuse and AlcoholismNeuroscience research and therapeutic targets.Alcohol Alert. 2004; 61: 1-6Google Scholar Baclofen for Alcohol Withdrawal: Not Comparable to the Gold Standard (Benzodiazepines)The American Journal of MedicineVol. 120Issue 6PreviewAddolorato et al1 showed that alcohol withdrawal (AW) symptoms decrease similarly when treated with diazepam or baclofen (albeit more slowly in the baclofen group). However, their conclusions that baclofen is comparable to the gold standard benzodiazepines and that baclofen may be considered a useful drug for treating AW are unwarranted. The authors do limit their recommendation to “uncomplicated” AW, but whether seizures or delirium will develop is not known until after a treatment decision has been made, and the course is completed. Full-Text PDF