Can baclofen be used in patients with liver damage or cirrhosis?

Is baclofen safe in people with liver damage, Hepatitis B or C infection or cirrhosis?

The simple answer is yes.

The simple reason is because baclofen is mostly broken down in the body by the kidneys, not the liver. Most baclofen in the body (85%) is simply passed out in the urine or faeces (stool). The other 15% is broken down in the liver but even very damaged livers can cope with this.

A 2007 study of 84 cirrhotic alcoholic patients showed that baclofen at 30mg/day was both effective and safe in this patient group.

There are restrictions for cirrhotic patients for both naltrexone (contraindicated in acute hepatitis or liver failure) and acamprosate (contraindicated in severe cirrhosis: Childs-Pugh class C).

Baclofen (and acamprosate) is largely excreted from the body via the kidneys so special attention is needed in patients with kidney disease.

The biggest problem with medications in patients with liver disease is that most medications are broken down (metabolised) by the liver and that’s what gets the medication out of the body. However a damaged liver can’t break down these medications in the normal way and this causes problems. The most common problem is that the medication lasts longer than normal in the body so it will accumulate and cause more effect than in normal people. An example is that diazepam (Valium) will make people with liver disease sleepier and more sedated than expected.

Baclofen is safe to use in patients with liver damage and even cirrhosis because most baclofen simply passes out in the urine and doesn’t rely on liver metabolism. That’s useful because patients with liver damage/cirrhosis really need something to help them stop drinking because their health and life depend on it.

Baclofen itself doesn’t reverse the liver damage caused by alcohol. It helps by assisting the patient to stop drinking alcohol, which is poisonous to liver cells. The liver can then heal itself as much as is possible.

The liver has a great capacity to heal itself by making new liver cells. This will happen when an alcoholic stops drinking alcohol. However if the liver is damaged by alcohol over a long period of time, it starts to heal itself with scar tissue rather than new liver cells and this is what causes cirrhosis of the liver. The cirrhosis itself, the scar tissue, cannot be reversed by stopping alcohol. However the liver cells which remain will function better if they are not constantly bathed in alcohol which poisons them. So patients with cirrhosis will still be healthier if they stop drinking, even though their liver will not return to normal. They will live longer and better than if they continued to drink.

Baclofen, Alcohol and Chronic Viral Hepatitis (B &C):

Hepatitis B and C are caused by viruses that attack and damage liver cells. They are spread when blood from an infected person gets into another person. This happens most often through needle sharing of injected drugs but also from mother to baby.

Baclofen is very helpful for alcoholic patients who are infected by hepatitis B or C. There is no problem in taking baclofen with the medications used in patients with liver disease, including the new medications for Hepatitis C treatment. Being able to stop and stay off alcohol with baclofen treatment is very beneficial in patients who already have liver damage from hepatitis B or C.

Hepatitis B generally causes an acute illness of fevers and jaundice but most adults will fight the infection and clear it from the body. About 5% of adult cases will be chronic; the body cannot rid itself of the virus, which continues to damage the liver over many years.

There is an effective vaccination against the hepatitis B virus which prevents people from getting infected.  There is also treatment for chronic Hepatitis B to slow down the liver damage but it doesn’t cure/clear the infection in most cases.

It is really important for these patients not to drink alcohol because the liver cells are already weakened by the viral infection. Alcohol causes a lot of additional damage and this causes the liver’s function to decline much more rapidly.

Hepatitis C is caused by another virus. This virus does not normally cause an acute illness of fevers and jaundice and the start of the infection usually goes unnoticed. However once infected, the body has great difficulties getting rid of the virus and 80% of those infected with Hepatitis C will have a chronic infection (vs 5% for hepatitis B).

There is no vaccine currently available to prevent hepatitis C but in the last couple of years, there have been great advances in medications to treat hepatitis C. There is now a range of very expensive but very effective medications which have cure rates of around 95% for chronic hepatitis C and this is great news.

Since March 1st 2016, these medications have been available on the PBS which makes them affordable to patients in Australia.

These new medications do not reverse any liver scarring which has occurred. However getting rid of the hepatitis C virus from the liver cells improves their function and stops further damage occurring. Again, not drinking alcohol, except in an occasional fashion, is beneficial to the liver in allowing the remaining liver cells to stay healthy.