Baclofen withdrawal: Difference between revisions
Neil.m.young (talk | contribs) (sources should be linked directly as ref in the text) |
Elcatracho (talk | contribs) |
||
| (7 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Baclofen (Lioresal) is an anti-spasmodic that works on the as a GABA- | *[[Baclofen]] (Lioresal) is an anti-spasmodic that works on the as a GABA-B agonist | ||
*Primarily used in patients with | *Primarily used in patients with [[multiple sclerosis]], [[cerebral palsy]], and spinal cord injuries | ||
*Often administered intrathecally but does | *Often administered intrathecally but does have an oral formulation | ||
*Withdrawal symptoms thought to be caused by decreased GABA activation | *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: | Baclofen withdrawal especially in the case of acute intrathecal pump failure may lead to: | ||
*High | *High [[fever]]s | ||
*Confusion | *[[Confusion]], altered mental status | ||
*Muscle stiffness | *Muscle stiffness | ||
*Seizures | *[[Seizures]] | ||
*Rhabdomyolysis | *[[Rhabdomyolysis]] | ||
*Multiple organ system failure | *Multiple organ system failure | ||
*Death | *Death | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Sepsis | *[[Sepsis]] | ||
*Meningitis | *[[Meningitis]] | ||
*Epilepsy | *[[Epilepsy]] | ||
*Autonomic dysreflexia | *Autonomic dysreflexia | ||
*Neuroleptic malignant syndrome | *[[Neuroleptic malignant syndrome]] | ||
*Malignant hyperthermia | *[[Malignant hyperthermia]] | ||
{{Template:Sedative/hypnotic withdrawal types}} | |||
==Evaluation== | ==Evaluation== | ||
*History | *History of baclofen use | ||
*Physical exam | |||
*Examination of the pump | *Examination of the pump | ||
*CPK levels | *CPK levels | ||
*Electrolytes | *Electrolytes | ||
*CBC | *CBC | ||
*LFTs | *[[LFTs]] | ||
*Coagulation studies | *Coagulation studies | ||
==Management== | ==Management== | ||
*High doses of benzodiazepines are the mainstay of treatment | *High doses of [[benzodiazepines]] are the mainstay of treatment | ||
*High dose oral baclofen has been used but has been less effective | *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 | *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 | *[[Dantrolene]] and [[cyproheptadine]] can also be considered but their efficacy is still unproven in this situation | ||
==Disposition== | ==Disposition== | ||
Admit: | Admit: | ||
*Organ failure | *Organ failure | ||
*Status epilepticus | *[[Status epilepticus]] | ||
*Pump malfunction | *Pump malfunction | ||
*Fever | *Fever | ||
*Loss of | *Loss of consciousness | ||
==See Also== | ==See Also== | ||
*[[Cerebral palsy]] | *[[Cerebral palsy]] | ||
*[[Baclofen toxicity]] | *[[Baclofen toxicity]] | ||
*[[Baclofen]] | |||
==External Links== | ==External Links== | ||
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