2021 AM Posters-Baclofen in the Management of Combined Alcohol and Phenibut

Baclofen in the Management of Combined Alcohol and Phenibut

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This case presentation discusses the management of alcohol withdrawal in a patient with a history of alcohol use disorder and phenibut abuse. The patient presented to the emergency department with a high blood alcohol level and symptoms of complicated alcohol withdrawal, including tachycardia, hypertension, agitation, tremors, and hallucinations. Initial treatment with benzodiazepines, haloperidol, dexmedetomidine, and gabapentin showed minimal improvement.<br /><br />Psychiatry was consulted on the fourth day of hospitalization, and they recommended adding valproic acid and a diazepam oral load. The patient received diazepam and showed improvement, allowing for the tapering of benzodiazepines. Baclofen, a GABA-b agonist, was also added to the regimen and rapidly improved the patient's symptoms.<br /><br />The patient was discharged with a regimen of a baclofen taper, valproic acid, and gabapentin for his combined alcohol and phenibut withdrawal. Over the next year, the patient presented multiple times with alcohol and phenibut withdrawal, and treatment with baclofen resulted in significant control of withdrawal symptoms compared to benzodiazepines alone.<br /><br />The case highlights the importance of screening for novel substances of abuse, such as phenibut, which can pose a clinical challenge in withdrawal management. Baclofen, with its GABA-b agonism, may be an effective treatment for combined alcohol and phenibut withdrawal. However, further research is needed to establish the efficacy and safety of baclofen for alcohol withdrawal.<br /><br />Overall, this case emphasizes the need for tailored withdrawal management strategies in patients with substance use disorders and the increasing prevalence of psychoactive substances obtained online.

Keywords

alcohol withdrawal

phenibut abuse

tachycardia

hypertension

agitation

tremors

hallucinations

benzodiazepines

baclofen

withdrawal management

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