Complications of baclofen overdosage

Ghose, Karabi; Holmes, K M; Matthewson, K

doi:10.1136/pgmj.56.662.865

Cited by 76 publications

(48 citation statements)

References 4 publications

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“…The pharmacokinetics of high-dose baclofen is characterized by a longer half-life [30]. The half-life is also increased in patients with renal insufficiency [33,34,35]. Approximately 25% of patients with spasticity are unresponsive even to higher oral doses of baclofen and require ITBA [36].…”

Section: Pharmacological Features Of Baclofenmentioning

confidence: 99%

Efficacy and Tolerability of Baclofen in Substance Use Disorders: A Systematic Review

Agabio¹,

Preti

Gessa

2013

Eur Addict Res

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Background: It has been reported that baclofen, a drug used in the treatment of spasticity, reduces the severity of withdrawal symptoms and substance use disorders (SUDs) for some psychoactive drugs. Aims and Methods: To evaluate the effectiveness and safety of baclofen in the treatment of withdrawal syndrome and/or SUDs, providing (1) an outline of its pharmacological features; (2) a summary of studies that have suggested its possible effectiveness in the treatment of SUDs, and (3) a review of randomized, controlled trials (RCTs) on baclofen and SUDs. Results: Baclofen tolerability is generally considered to be good. Eleven RCTs investigated its effectiveness in the treatment of SUDs. Of these, 5 RCTs found that baclofen is effective, 5 RCTs found that it is ineffective and the results of 1 RCT were not appreciable because it did not achieve the preplanned level of participation. Conclusions: The number of RCTs on baclofen and SUDs is still low, and their results are divergent. Further RCTs should be undertaken, particularly with higher doses of baclofen. Its administration may be suggested in patients who fail to respond to other approved drugs or who are affected by liver disease that prevents their administration, or in patients affected by SUDs for which no approved drugs are available. Treatment should be conducted under strict medical supervision.

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Section: Pharmacological Features Of Baclofenmentioning

confidence: 99%

Efficacy and Tolerability of Baclofen in Substance Use Disorders: A Systematic Review

Agabio¹,

Preti

Gessa

2013

Eur Addict Res

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“…2-4,6 -8 Miosis is more common than mydriasis 2,6,7 and pupil reactivity is typically lost. 5 Ventilatory support (mean length of 40 hours 2 ) is often required, particularly when ingestion exceeds 200 mg. 3 Seizures may be related to baclofen toxicity or withdrawal.…”

Section: Discussionmentioning

confidence: 99%

“…5 Myoclonus (epileptic or encephalopathic in origin) has been reported. 7 The most common EEG findings in baclofen toxicity are burst suppression 4,8 and nonspecific diffuse slowing 9 but other EEG patterns have been reported as well. 8 Laboratory abnormalities include transient elevation of hepatic enzymes, hyperglycemia, and leukocytosis.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Though recommended, gastric lavage and activated charcoal may be of little use given the rapid absorption of baclofen from the alimentary tract. 7 Atropine, 2,5 physostigmine, 2,4 flumazenil, 4 ondansetron, 5 and hemodialysis 6 have been used but none are supported by controlled studies. Baclofen withdrawal syndrome may occur in patients on chronic therapy and is typically more severe in intrathecal baclofen therapy.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Reasoning: A 41-year-old comatose man with absent brainstem reflexes

2012

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A 41-year-old obese man was stopped by the police for driving erratically. He was confused, dysarthric, ataxic, and vomited repeatedly before collapsing and becoming rapidly obtunded, eventually requiring rapid sequence intubation (RSI). He arrived at the emergency department (ED) with a Glasgow Coma Scale score of 3, hypothermia (35.3°C), and hypotension (78/38 mm Hg), with a heart rate of 80. He was treated with warm IV fluid boluses and warming blanket. He was examined by the attending and resident neurologists approximately 2.5 hours from the time of RSI. He was mechanically ventilated but had received no sedation since intubation. Nothing was known about his medical history and no collateral information was available.He did not respond to naloxone or thiamine. Clinical examination was performed with a temperature of 36°C and a blood pressure of 120/80 mm Hg. He remained mechanically ventilated without spontaneous respirations. No meningismus, external signs of trauma, needle puncture marks, or tongue or buccal lacerations were observed. Spontaneous movements were absent. He did not open his eyes, grimace, withdraw, or posture to noxious stimuli (nailbed and supraorbital pressure). Neuromuscular blockade was excluded with a train of 4 twitches with maximal ulnar nerve stimulation. His pupils were fixed at 2 mm and unreactive to light. Corneal and oculocephalic (vertical and horizontal) reflexes were absent. Irrigation of each ear canal with ice water produced no eye deviation. No gag or cough reflexes were elicited with posterior pharyngeal stimulation and tracheal suctioning respectively. His extremities were flaccid and areflexic. Babinski sign was absent. No gaze deviation, nystagmoid eye movements, facial twitching, or jerking movements were observed. Cardiovascular, lung, and abdominal examinations were unremarkable.

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“…The drug is rapidly absorbed from the gastrointestinal tract, reaching peak plasma concentrations after 2 hours. 30% of the drug is bound to plasma proteins and is partially metabolized in the liver (10-15%) and then removed by the kidneys [2,3,4].…”

Section: Introductionmentioning

confidence: 99%

Correlation between the single, high dose of ingested baclofen and clinical symptoms

Anand

Zając

Waldman

et al. 2017

Ann Agric Environ Med.

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Introduction and Objectives. Baclofen is a drug used mainly to treat muscle spasticity. Its overdose can lead to lifethreatening clinical symptoms, including acute respiratory failure requiring mechanical ventilation. The aim of this study was to assess the prevalence of selected clinical symptoms associated with baclofen poisoning comparing to an ingested dose. Materials and method. 60 cases of oral baclofen poisoning were analyzed. Gender, age distribution, and correlation between the dose of ingested baclofen were studied, as well as and following clinical parameters: degree of altered consciousness, heart rate, blood pressure, presence of acute respiratory failure, duration of mechanical ventilation, and presence of psychotic symptoms. Results. The study found statistically significant correlations between dosage of ingested baclofen and presence of acute respiratory failure, as well as duration of mechanical ventilation. No statistically significant correlations were found between the dose of ingested baclofen and presence of hypertension, bradycardia, acute psychotic symptoms, or level of consciousness disturbance. However, it was found that patients who suffered from hypertension, bradycardia, and altered mental status ingested a larger dose of baclofen. Conclusions. There is a statistically significant correlation between the dose of ingested baclofen and the presence of acute respiratory failure, and duration of mechanical ventilation. Patients who have taken a single dose of baclofen of 200 mg, or higher, should be managed in centres able to provide continuous monitoring of life functions. Those with a higher level of a single dose of baclofen ingestion (>500 mg), should be hospitalized in a Toxicology Unit or Intensive Care Unit able to provide airway support and mechanical ventilation.

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Complications of baclofen overdosage

Cited by 76 publications

References 4 publications

Efficacy and Tolerability of Baclofen in Substance Use Disorders: A Systematic Review

Efficacy and Tolerability of Baclofen in Substance Use Disorders: A Systematic Review

Clinical Reasoning: A 41-year-old comatose man with absent brainstem reflexes

Correlation between the single, high dose of ingested baclofen and clinical symptoms

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