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| {{decree|type=notice|message=This article is in the 'Talk' namespace because it is an unfinished draft. This section is used to host drafts for unpublished articles as well as discussions for published ones. If you'd like to use this area to discuss this draft, please do so in the 'Discussion' section at the very bottom of the page. This notice will be removed once this draft has been approved for publication by an administrator.}}
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| {{headerpanel|{{Approval}}{{DepressantOD|GABAergics}} }}
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| {{SummarySheet}}
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| {{SubstanceBox/Baclofen}}
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| '''Baclofen''' (also known as '''Lioresal''', '''Gablofen''', '''Kemstro''', '''Liofen''') is a [[psychoactive class::depressant]] substance of the [[chemical class::gabapentinoid]] class. It is a derivative of [[GABA]] and is chemically related to [[phenibut]], [[pregabalin]], and [[gabapentin]]. It primarily acts as a [[GABA]]<sub>B</sub> [[receptor]] [[agonist]].
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| Baclofen was synthesized in 1962 at Ciba-Geigy, a Swiss pharmaceutical company.<ref name="Froestl">Froestl, Wolfgang (2010). "Chemistry and Pharmacology of GABAb Receptor Ligands". In Blackburn, Thomas P. (ed.). GABAb Receptor Pharmacology – A Tribute to Norman Bowery. Advances in Pharmacology. 58. pp. 19–62. doi:10.1016/S1054-3589(10)58002-5. ISBN 978-0-12-378647-0. PMID 20655477.</ref> Today, it is used clinically to treat muscle spasticity, and holds promise as a treatment for [[alcoholism]].<ref>Clinical effectiveness of baclofen for the treatment of alcohol dependence: a review. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/23869179</ref>
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| [[Subjective effects]] include [[sedation]], [[anxiety suppression]], [[muscle relaxation]], and moderate [[euphoria]]. It is usually described as somewhat similar to [[phenibut]] in its effects.
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| It is highly advised to use [[harm reduction practices]] if using this substance.
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| ==History and culture==
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| Baclofen was synthesized in 1962 by Heinrich Keberle at Ciba (pharmaceutical company) in Basel, Switzerland, based on the idea of enhancing the lipophilicity of GABA in order to achieve penetration of the blood-brain barrier.<ref name="Froestl" /> It was marketed as '''Lioresal''' in 1972.<ref name="Froestl" />
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| In his 2008 book, ''Le Dernier Verre'' (translated literally as "The Last Glass" and published in English as "The End of my Addiction"), French-American cardiologist Olivier Ameisen described how he treated his alcoholism with baclofen. Inspired by this book, an anonymous donor gave $750,000 to the University of Amsterdam to initiate a clinical trial of high-dose baclofen, which Ameisen had called for since 2004.<ref>Enserink, M. (2011). "Anonymous Alcoholic Bankrolls Trial of Controversial Therapy". Science. 332 (6030): 653. doi:10.1126/science.332.6030.653. PMID 21551041.</ref>
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| ==Chemistry==
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| As with [[phenibut]], baclofen is a derivative of γ-aminobutyric acid ([[GABA]]), except with a chlorine-substituted phenyl group in the β-position of the molecule. It is a chiral molecule and thus has two potential configurations as (R)- and (S)-enantiomers. It has an almost identical chemical structure to [[F-phenibut]] (only replacing a fluorine with a chlorine atom in the para-position of the phenyl group). Baclofen is a white (or sometimes off-white) mostly odorless crystalline powder, with a molecular weight of 213.66 g/mol and it is somewhat soluble in water.
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| ==Pharmacology==
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| Baclofen produces its effects by activating the [[GABA]]<sub>B</sub> [[receptor]], similar to the drug [[phenibut]] which also activates this [[receptor]] and shares some of its effects. Baclofen is postulated to block mono-and-polysynaptic reflexes by acting as an inhibitory ligand, inhibiting the release of excitatory [[neurotransmitter]]s.
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| Similarly to [[phenibut]] (β-phenyl-GABA), as well as [[pregabalin]] (β-isobutyl-GABA), which are close analogues of baclofen, baclofen (β-(4-chlorophenyl)-GABA) has been found to block α2δ subunit-containing voltage-gated calcium channels (VGCCs). However, it is weaker relative to phenibut in this action (Ki = 23 and 39 μM for R- and S-phenibut and 156 μM for baclofen). Moreover, baclofen is in the range of 100-fold more potent by weight as an agonist of the [[GABA]]<sub>B</sub> receptor in comparison to [[phenibut]], and in accordance, is used at far lower relative dosages. As such, the actions of baclofen on α2δ subunit-containing VGCCs are likely not clinically-relevant.<ref>R-phenibut binds to the α2-δ subunit of voltage-dependent calcium channels and exerts gabapentin-like anti-nociceptive effects. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/26234470</ref>
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| The drug is rapidly absorbed after oral administration and is widely distributed throughout the body. Biotransformation is low: the drug is predominantly excreted unchanged by the kidneys.<ref>Plasma and urinary excretion kinetics of oral baclofen in healthy subjects. (link.springer.com / SpringerLink) | https://link.springer.com/article/10.1007/BF00558228</ref>
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| ==Subjective effects==
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| Baclofen is often compared to [[phenibut]], but more "messy"", less [[euphoric]], [[Anxiety suppression|anskiolytic]], and causing a stronger [[dizziness]].
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| {{Preamble/SubjectiveEffects}}
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| {{effects/base
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| |{{effects/physical|
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| *'''[[Effect::Stimulation]]''' and '''[[Effect::Sedation]]''' - Baclofen has different effects on physical energy levels depending on the dosage used. At lower doses, baclofen has a mild physical and mental stimulation effect, encouraging movement, wakefulness, and productivity. At common doses and higher, baclofen is physically sedating, encouraging sleep and lethargy.
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| *'''[[Effect::Physical euphoria]]''' - Compared to [[gabapentinoids]] (such as [[phenibut]]) and [[benzodiazepines]], baclofen is considered less euphoric.
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| *'''[[Effect::Muscle relaxation]]'''
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| *'''[[Effect::Respiratory depression]]'''
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| *'''[[Effect::Nausea]]'''
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| *'''[[Effect::Orgasm suppression]]'''
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| *'''[[Effect::Increased libido]]''' - This affect is more pronounced at lower doses.
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| *'''[[Effect::Pain relief]]'''
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| *'''[[Effect::Motor control loss]]'''
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| *'''[[Effect::Dizziness]]''' - Compared to [[gabapentinoids]] (such as [[phenibut]]), baclofen has stronger dizziness.
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| *'''[[Effect::Headaches]]'''
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| *'''[[Effect::Pupil dilation]]'''
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| *'''[[Effect::Appetite enhancement]]'''
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| *'''[[Effect::Frequent urination]]'''
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| *'''[[Effect::Difficulty urinating]]'''
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| }}
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| |{{effects/cognitive|
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| *'''[[Effect::Anxiety suppression]]''' - This effect is less pronounced compared to [[gabapentinoids]] or [[benzodiazepines]].
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| *'''[[Effect::Disinhibition]]'''
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| *'''[[Effect::Compulsive redosing]]'''
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| *'''[[Effect::Cognitive euphoria]]''' - Compared to [[gabapentinoids]] (such as [[phenibut]]) and [[benzodiazepines]], this effect is pronounced less.
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| *'''[[Effect::Empathy, affection, and sociability enhancement]]'''
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| *'''[[Effect::Motivation enhancement]]'''
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| *'''[[Effect::Analysis suppression]]'''
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| *'''[[Effect::Thought deceleration]]'''
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| *'''[[Effect::Increased music appreciation]]'''
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| *'''[[Effect::Amnesia]]'''
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| *'''[[Effect::Addiction suppression]]''' - Baclofen also used for alcoholism treatment.
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| *'''[[Effect::Confusion]]'''
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| }}
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| {{effects/aftereffects|
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| *'''[[Effect::Anxiety|Rebound anxiety]]'''
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| *'''[[Effect::Sleepiness|Residual sleepiness]]''' - This affect is mostly caused by decreased blood pressure.
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| *'''[[Effect::Cognitive fatigue]]''' - This affect is mostly caused by decreased blood pressure.
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| *'''[[Effect::Compulsive redosing]]''' - This effect is generally caused by the anxiety user experiences during the comedown.
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| *'''[[Effect::Decreased blood pressure|Low Blood Pressure]]'''
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| *'''[[Effect::Decreased heart rate|Low Heart Rate]]'''
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| *'''[[Effect::Depression]]'''
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| *'''[[Effect::Depersonalization]]'''
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| *'''[[Effect::Dream potentiation]]'''
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| }}
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| }}
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| ===Experience reports===
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| There are currently no anecdotal reports which describe the effects of this compound within our experience index. Additional experience reports can be found here:
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| * [https://www.erowid.org/experiences/subs/exp_Pharms_Baclofen.shtml Erowid Experience Vaults: Baclofen]
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| ==Toxicity and harm potential==
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| {{toxicity}}
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| Baclofen has a [[Toxicity::low toxicity]] relative to dose.<ref>A pilot study assessing pharmacokinetics and tolerability of oral and intravenous baclofen in healthy adult volunteers. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/25028414</ref> However, it is [[Toxicity::potentially [[respiratory depression|lethal]] when mixed with [[depressants]] like [[alcohol]], [[benzodiazepines]] or [[opioids]]]].
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| It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this substance.
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| ===Tolerance and addiction potential===
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| Baclofen is [[Addiction potential::moderately physically and psychologically addictive]]. Discontinuation of baclofen can be associated with a withdrawal syndrome which resembles [[benzodiazepine]] [[withdrawal]] and [[alcohol]] withdrawal. Withdrawal symptoms are more likely if baclofen is used for long periods of time (more than a couple of months) and can occur from low or high doses. The severity of baclofen withdrawal depends on the rate at which it is discontinued. Abrupt withdrawal is more likely to result in severe withdrawal symptoms. Acute withdrawal symptoms can be stopped by recommencing baclofen.<ref>Delirium associated with baclofen withdrawal: a review of common presentations and management strategies. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/16288128</ref>
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| Tolerance will develop to the sedative-hypnotic effects [[Time to full tolerance::within a couple of days of continuous use]]. After cessation, the tolerance returns to baseline in [[Time to zero tolerance::7 - 14 days]]. Withdrawal symptoms or rebound symptoms may occur after ceasing usage abruptly following a few weeks or longer of steady dosing and may necessitate a [[tapering|gradual dose reduction]]. Withdrawal symptoms may include [[auditory hallucinations]], [[hallucinations|visual hallucinations]], [[tactile hallucinations]], [[delusions]], [[confusion]], [[delirium]], [[disorientation]], fluctuation of consciousness, [[insomnia]], [[dizziness]], [[nausea]], [[Focus suppression|inattention]], [[Memory suppression|memory impairments]], perceptual disturbances, [[itchiness]], [[anxiety]], [[depersonalization]], hypertonia, [[hyperthermia]], [[psychosis]], [[mania]], mood disturbances, [[tachycardia]], [[seizures]], tremors, autonomic dysfunction, hyperpyrexia (fever), extreme muscle rigidity resembling [[Antipsychotics|neuroleptic]] malignant syndrome and rebound spasticity.<ref>[Severe hyperthermia caused by sudden withdrawal of continuous intrathecal administration of baclofen]. (PubMed.gov / NCBI) | https://www.ncbi.nlm.nih.gov/pubmed/9033759</ref>
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| Baclofen produces cross-tolerance with [[Cross-tolerance::all [[GABA]]genic depressants]], meaning that after its consumption, depressants will have a reduced effect.
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| ===Dangerous interactions===
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| {{DangerousInteractions/Intro}}
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| *'''[[Depressants]]''' (''[[DangerousInteraction::1,4-Butanediol]], [[DangerousInteraction::2M2B]], [[DangerousInteraction::alcohol]], <ref>Koski, A., Ojanperä, I., & Vuori, E. (2002). Alcohol and benzodiazepines in fatal poisonings. Alcoholism: Clinical and Experimental Research, 26(7), 956-959.</ref> [[DangerousInteraction::benzodiazepines]], [[DangerousInteraction::barbiturates]], [[DangerousInteraction::GHB]]/[[DangerousInteraction::GBL]], [[DangerousInteraction::methaqualone]], [[DangerousInteraction::opioids]]'') - This combination can result in dangerous or even fatal levels of [[respiratory depression]]. These substances potentiate the [[muscle relaxation]], [[sedation]] and [[amnesia]] caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the [[recovery position]] or have a friend move them into it.
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| *'''[[Dissociatives]]''' - This combination can result in an increased risk of vomiting during unconsciousness and dying from the resulting suffocation. If a sudden loss of consciousness occurs, users should attempt to fall asleep in the [[recovery position]] or have a friend move them into it.
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| *'''[[Stimulants]]''' - It is dangerous to combine baclofen with [[stimulant]]s due to the risk of excessive intoxication. Stimulants mask the [[sedation|sedative]] effect of baclofen, which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of baclofen will be significantly increased, leading to intensified [[disinhibition]] as well as [[Baclofen#Subjective effects|other effects]]. If combined, one should strictly limit themselves to only dosing a certain amount of baclofen per hour. This combination can also potentially result in severe dehydration if hydration is not monitored.
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| ==Legal status==
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| {{legalStub}}
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| *'''Germany''': Baclofen is a prescription medicine, according to Anlage 1 AMVV.<ref>{{cite web|url=https://www.gesetze-im-internet.de/amvv/anlage_1.html|access-date=November 13, 2020|title=Anlage 1 AMVV|publisher=Bundesministerium der Justiz und für Verbraucherschutz [Federal Ministry of Justice and Consumer Protection]|language=de}}</ref>
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| *'''Russia''': Baclofen is available through a prescription.{{citation needed|date=November 2020}}
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| *'''Sweden''': Baclofen is available through a prescription.<ref>{{cite web|url=https://fass.se/LIF/product?userType=2&nplId=19861107000083}}</ref>
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| *'''Turkey''': Baclofen is available at pharmacies without prescription.{{citation needed|date=November 2020}}
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| ==See also==
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| *[[Responsible use]]
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| *[[Depressant]]
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| *[[Gabapentinoid]]
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| *[[GABA]]
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| *[[Phenibut]]
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| *[[F-Phenibut]]
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| *[[Gabapentin]]
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| *[[Pregabalin]]
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| ==External links==
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| *[https://en.wikipedia.org/wiki/Baclofen Baclofen (Wikipedia)]
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| *[https://www.erowid.org/pharms/baclofen/ Baclofen (Erowid Vault)]
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| *[https://isomerdesign.com/PiHKAL/explore.php?id=2379 Baclofen (Isomer Design)]
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| ==References==
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| <references/>
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| [[Category:Psychoactive substance]]
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| [[Category:Phenethylamine]]
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| [[Category:Depressant]]
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| [[Category:Proofread]]
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| {{#set:Featured=true}}
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