Baclofen withdrawal: Difference between revisions
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==Background== | ==Background== | ||
*Baclofen or the trade name Lioresal is an anti-spasmodic that works on the as a GABA agonist. It is primarily used in patients with Multiple Sclerosis, Cerebral Palsy and Spinal Cord injuries. It is often administered intrathecally but does also have an oral formulation. | *Baclofen or the trade name Lioresal is an anti-spasmodic that works on the as a GABA-b agonist. It is primarily used in patients with Multiple Sclerosis, Cerebral Palsy and Spinal Cord injuries. It is often administered intrathecally but does also have an oral formulation. | ||
*Withdrawal symptoms caused by decreased GABA | *Withdrawal symptoms thought to be caused by decreased GABA activation | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 01:10, 1 August 2016
Background
- Baclofen or the trade name Lioresal is an anti-spasmodic that works on the as a GABA-b agonist. It is primarily used in patients with Multiple Sclerosis, Cerebral Palsy and Spinal Cord injuries. It is often administered intrathecally but does also have an oral formulation.
- Withdrawal symptoms thought to be caused by decreased GABA activation
Clinical Features
Baclofen withdrawal especially in the case of acute intrathecal pump failure may lead to:
- High Fevers
- Confusion
- Altered mental status
- Muscle stiffness
- Seizures
- Rhabdomyolysis
- Multiple organ system failure
- Death
Differential Diagnosis
- Sepsis
- Meningitis
- Epilepsy
- Autonomic dysreflexia
- Neuroleptic malignant syndrome
- Malignant hyperthermia
Evaluation
- History and Physical of Baclofen use
- Examination of the pump
- CPK levels
- Electrolytes
- CBC
- LFTs
- Coagulation studies
Management
- High doses of benzodiazepines are the mainstay of treatment
- High dose oral baclofen has been used but has been less effective
- Intrathecal baclofen bolus can be attempted but overdoses are possible with this method
- Dantrolene and cyproheptadine can also be considered but their efficacy is still unproven in this situation.
Disposition
Admit:
- Organ failure
- Status epilepticus
- Pump malfunction
- Fever
- Loss of Consciousness
See Also
External Links
References
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC514562/ https://www.drugs.com/cdi/baclofen.html http://www.ncbi.nlm.nih.gov/pubmed/9711203 http://www.clineu-journal.com/article/S0303-8467(02)00009-4/abstract https://www.uptodate.com/contents/baclofen-drug-information?source=search_result&search=baclofen&selectedTitle=1~75