Olivier Ameisen – www.thelancet.com Vol 373 May 2, 2009
In the treatment of alcohol dependence, Marc Schuckit (Feb 7, p 492)1 omits baclofen. This is most regrettable for two reasons. First, Schuckit’s proposed treatment excludes patients with liver cirrhosis from receiving any anticraving medication. Alcohol intake in patients with cirrhosis is associated with high mortality.2 With cirrhosis, naltrexone is contraindicated and the safety of acamprosate, topiramate, and disulfi ram has not been tested because these agents undergo extensive liver metabolism. Baclofen is the only anticraving medication shown in a randomised trial3 to be safe and eff ective at promoting abstinence in patients with cirrhosis. Depriving cirrhosis patients of baclofen would deprive them of the benefit patients without cirrhosis get from standard anticraving treatment.
Treatment of alcohol-use disorders
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