The End of My Addiction
slows the heart rate around five beats below other beta-blockers. In other words, if a competing beta-blocker brought the heart rate down to 63 beats per minute, nadolol would lower it to 58 beats per minute because of its more powerful effect on the sympathetic nervous system.
Some children have an arrhythmia and go into fainting spells (syncope) that are related to effort or emotion. This is due to severe ventricular tachycardia that is mediated by catecholamines. If the diagnosis is delayed, the outcome is poor. Whereas other beta-blockers may fail to prevent the phenomenon even if they are used at maximal dosage, nadolol will often do so completely.
In New York, I transposed this to some adult patients, including quite a few who came to see me for a second opinion because their cardiologists had told them that bypass surgery was their last resort against crippling daily chest pain that did not respond to other beta-blockers at the highest dose. When I thought patients could benefit from nadolol, I explained how I knew about it and even told them, “This effect of the medication is virtually unknown here, so if you have a problem, you’ll have a good basis for suing me.” Fortunately, the patients I gave nadolol did well on it, and it helped many of them avoid invasive surgery.
Amiodarone was another heart medication I learned to use in France. When I came to New York Hospital–Cornell in 1983 and suggested amiodarone for patients, colleagues said, “No way,” and referred to American studies showing that amiodarone frequently induced severe pulmonary fibrosis. I looked up the data, and saw that the studies had been of massive doses far in excess of what was needed. It was as if I did a study where I gave people megadoses of aspirin and then said, “Aspirin is toxic. It causes internal bleeding.” I kept telling colleagues, “Amiodarone is safe, and it is the best medication in many cases—if you use it at the right dose for the right indication.” It took more than ten years for American cardiologists to begin accepting amiodarone. In the meantime, I treated a number of patients, again including quite a few who came to me for second opinions, with low-dose amiodarone. I advised them, “I’m prescribing this off-label, as I’ve explained. You’ll have a win-win situation, if you decide to sue me.” Fortunately, the patients did well on low-dose amiodarone, and they were grateful to be spared pacemakers as a result.
After reading the abstract of the paper by Breslow et al., I scanned the other Google hits for “baclofen panic” and clicked through a few of the links, but found nothing as interesting. A bit later I decided to Google the keywords “baclofen anxiety,” and again I immediately struck what seemed like gold. It was a link to an abstract of a 1993 paper in the journal Drug and Alcohol Dependence by the Russian researcher E. M. Krupitsky et al., entitled “Baclofen administration for the treatment of affective disorders in alcoholic patients.”
I eagerly clicked the link and read the brief abstract. It said that ninety alcoholic patients with anxiety and/or depression had been divided into four groups receiving either baclofen, a benzo, an antidepressant, or a placebo. Baclofen, the benzo, and the antidepressant were all equally more effective than placebo at relieving anxiety and depression, but baclofen “[did] not have the side-effects and complications” of the benzo and the antidepressant. Unfortunately, the abstract did not say how much baclofen was used, but I was excited to read that it had been shown to be effective against anxiety in a randomized clinical trial.
Finally I put the keywords “baclofen alcohol” into the Google search engine. The first hit brought up the Italian researcher whose name Anna Rose Childress couldn’t quite remember. It had to be. “Dolo-something,” she had said, and here was a link to the abstract of a 2000 paper, “Ability of baclofen in reducing alcohol craving and intake,” by G. Addolorato et al., in the journal Alcoholism: Clinical and Experimental Research :
BACKGROUND: Accumulating evidence shows the efficacy of…baclofen in reducing alcohol intake in rats, but no studies have been performed in alcoholics. In the present preliminary study we investigated the effect of short-term baclofen administration on craving for alcohol, ethanol intake, and abstinence from alcohol in alcoholic individuals.
METHODS: Ten male
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