An endogenous 4-carbon fatty acid. Neurotransmitter in the regulation of sleep, haemodynamics, emotion and memory.
Sedative with a major paradoxical indication of being a drug of choice in cataplexy although its effectiveness is not absolute and unpredictable.
Also used as a drug of abuse.
Oral 2.25g taken upon going to bed and again about 2.5 to 4 hours later. Titrate to effect in dose increments of 1.5 g/day every week or so to a maximum of 9 g/day.
- As respiratory depressant doses over 6g/day should be stringently evaluated in patients with concomitant sleep apnoea. Its use of monotherapy may be more dangerous as most patients in clinical trials were also on a CNS stimulant.
- No head to head data with clomipramine
- Cost effectiveness is low at 2015 prices
Cautions and Interactions
- Hypnotics or other CNS depressants
- Withdrawal (see below) can cause:
Has sympathomimetic effects.
Issues in substance abuse context
As of 2016 one of common drugs of abuse in UK because of relative cheapness and availability. It has a narrow therapeutic index between the desired euphoria/disinhibition/increased confidence and depression manifest as coma (G coma) with further risk of cardiac and respiratory depression. Treatment is supportive with benzodiazepines for agitation. Regular uses can be taking it every few hours.
Chronic abusers can have a very severe withdrawal reaction with hallucinosis, agitation and tremor. In adults very large doses of benzodiazepines may be required, with typical initial doses of diazepam of 20mg and up to 180mg/24 hours as inpatient. [[Baclofen] 10mg up to tds may also be indicated. Indeed baclofen may be used to prevent relapse. Some community withdrawal regimes have used up to 50mg/24 hours without respiratory depression issues.
- ↑ Collins. Child vs NHS England High Court Neutral Citation Number: (2016) EWHC 1395 (Admin)No: CO/4007/2015
- ↑ Hicks AR, Varner KJ. Cardiovascular responses elicited by intragastric administration of BDL and GHB. Journal of receptor and signal transduction research. 2008; 28(4):429-36.( Link to article – subscription may be required.)
- ↑ LeTourneau JL, Hagg DS, Smith SM. Baclofen and gamma-hydroxybutyrate withdrawal. Neurocritical care. 2008; 8(3):430-3.(Link to article – subscription may be required.)
- ↑ Kamal RM, Loonen AJ, Dijkstra BA, De Jong CA. Baclofen as relapse prevention in the treatment of gamma-hydroxybutyrate dependence: a case series. Journal of clinical psychopharmacology. 2015 Jun; 35(3):313-8.(Link to article – subscription may be required.)