Baclofen withdrawal: Difference between revisions
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==Background== | ==Background== | ||
*[[Baclofen]] (Lioresal) is an anti-spasmodic that works on the as a GABA-B agonist | |||
*Primarily used in patients with [[multiple sclerosis]], [[cerebral palsy]], and spinal cord injuries | |||
*Often administered intrathecally but does have an oral formulation | |||
*Withdrawal symptoms thought to be caused by decreased GABA activation | |||
==Clinical Features== | ==Clinical Features== | ||
Baclofen withdrawal especially in the case of acute intrathecal pump failure may lead to: | |||
*High [[fever]]s | |||
*[[Confusion]], altered mental status | |||
*Muscle stiffness | |||
*[[Seizures]] | |||
*[[Rhabdomyolysis]] | |||
*Multiple organ system failure | |||
*Death | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Sepsis]] | |||
*[[Meningitis]] | |||
*[[Epilepsy]] | |||
*Autonomic dysreflexia | |||
*[[Neuroleptic malignant syndrome]] | |||
*[[Malignant hyperthermia]] | |||
== | {{Template:Sedative/hypnotic withdrawal types}} | ||
==Evaluation== | |||
*History of baclofen use | |||
*Physical exam | |||
*Examination of the pump | |||
*CPK levels | |||
*Electrolytes | |||
*CBC | |||
*[[LFTs]] | |||
*Coagulation studies | |||
==Management== | ==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== | ==Disposition== | ||
Admit: | |||
*Organ failure | |||
*[[Status epilepticus]] | |||
*Pump malfunction | |||
*Fever | |||
*Loss of consciousness | |||
==See Also== | ==See Also== | ||
*[[Cerebral palsy]] | *[[Cerebral palsy]] | ||
*[[Baclofen toxicity]] | *[[Baclofen toxicity]] | ||
*[[Baclofen]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | |||
Latest revision as of 05:36, 28 January 2021
Background
- Baclofen (Lioresal) is an anti-spasmodic that works on the as a GABA-B agonist
- Primarily used in patients with multiple sclerosis, cerebral palsy, and spinal cord injuries
- Often administered intrathecally but does 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
Sedative/hypnotic withdrawal
- Toxic alcohols
- Benzodiazepines
- Flunitrazepam (Rohypnol)
- Gamma hydroxybutyrate (GHB)
- Baclofen
- Barbiturates
- Opioids
- Chloral hydrate
Evaluation
- History of baclofen use
- Physical exam
- 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