Baclofen Dosing for Methamphetamine Cravings
The evidence does not support using baclofen for methamphetamine cravings, as the only randomized controlled trial showed no statistically significant benefit at the standard dose of 20 mg three times daily (60 mg/day total). 1
Evidence Quality and Limitations
The single RCT examining baclofen for methamphetamine dependence used 20 mg three times daily (60 mg/day total) over 16 weeks and found no main treatment effect in reducing methamphetamine use compared to placebo. 1
Important caveats from this study:
- A post-hoc analysis suggested baclofen might have a small effect in participants with higher medication adherence, but this was exploratory and not the primary outcome 1
- The study was underpowered and the effect size, if present, appears minimal 1
- This is the only controlled trial data available for this specific indication
Context from Alcohol Use Disorder Literature
While baclofen has demonstrated efficacy for alcohol cravings, the dosing and mechanism may not translate to methamphetamine:
Standard alcohol dependence dosing:
- 30-60 mg/day (10 mg three times daily to 20 mg three times daily) is the guideline-recommended range 2
- One RCT in alcohol-dependent patients with liver cirrhosis used 30 mg/day (10 mg three times daily) with benefit 2
Higher dose regimens for alcohol:
- Some case reports and observational studies have used up to 270-300 mg/day for severe alcohol dependence 3, 4
- Dose-response effects have been demonstrated in alcohol dependence, with 60 mg/day showing greater efficacy than 30 mg/day 5
Clinical Bottom Line
Given the lack of efficacy in the only controlled trial at 60 mg/day and the absence of any supporting evidence for higher doses in methamphetamine dependence, baclofen cannot be recommended for managing methamphetamine cravings. 1 The pharmacology that makes baclofen effective for alcohol withdrawal and cravings (GABA-B agonism) does not appear to translate to stimulant use disorders, which involve different neurotransmitter systems (primarily dopamine). 1
If baclofen were to be attempted off-label despite limited evidence, the only studied dose is 20 mg three times daily (60 mg/day), but clinicians should have very low expectations for efficacy and consider alternative evidence-based treatments for methamphetamine use disorder instead. 1