Ver el código de «Baclofen toxicity»

==Background==
[[File:BACLOFEN.jpeg|thumb|Tablets of Baclofen]]
[[File:Baclofen.svg|thumb]]
*Baclofen is a synthetic derivative of GABA used to reduce spasticity in conditions such as [[multiple sclerosis]] and [[cerebral palsy]], or to reduce muscular spasm in [[lower back pain]].<ref>Jung, M. “Baclofen Overdoses”. Maryland Poison Center, University of Maryland School of Pharmacy. www.mdpoison.com Accessed April 29th, 2014.</ref>
**May also be used for [[hiccups]] and [[alcohol use disorder]]
*At therapeutic doses, baclofen acts as a GABA-B receptor agonist in the spinal cord, causing inhibition of muscular tone.
*At higher doses, baclofen loses selectivity and can cause sedation.
*Primarily (80%) excreted by the kidneys
**Dosage must be reduced in renal dysfunction and should be avoided with GFR < 30 mL/min/1.73 m<sup>2</sup>.
**Patients on chronic therapy may become toxic with new [[Acute kidney injury|AKI]].

==Clinical Features==
*[[Nausea and vomiting]]
*[[Depressed level of consciousness]]<ref>Nicola Y Leung, Ian M Whyte, Geoffrey K Isbister Baclofen overdose: defining the spectrum of toxicity. Emerg Med Australas: 2006, 18(1);77-82</ref>
*[[Delirium]]
*[[Seizures]]
**Tonic-clonic
**Non-convulsive status epilepticus
*Myoclonus
*Airway compromise and [[respiratory failure]]
*[[Hypothermia]]
*[[Hypotension]]
*[[Bradycardia]] and conduction abnormalities

==Differential Diagnosis==
{{Template:Sedatve/hypnotic toxicity types}}
===Also consider co-ingestion with intentional overdose===
*[[Acetaminophen toxicity]]
*[[Salicylate toxicity]]
*[[Ethanol toxicity]]

==Evaluation==
*Diagnosis of exclusion, based on history
**Baclofen level can be measured but is not clinically useful
*In patients with [[Intrathecal drug delivery system complications|intrathecal baclofen pump]]:
**Obtain [[KUB]] to evaluate pump tubing integrity and placement
**Consult the managing specialist to interrogate pump

==Management==
*[[Activated charcoal]] for recent ingestion
*Supportive care:
**Respiratory support<ref>*Dease NM, et al. Baclofen Toxicity. Updated 2023 Mar 20. In: ''StatPearls''. Treasure Island, FL: StatPearls Publishing; 2025 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK580550. Accessed Oct 13, 2025.</ref>
**[[IV fluids]]
**[[Vasopressors]] for persistent hypotension
**[[Benzodiazepines]] for [[seizures]] or severe myoclonus
***CNS depressive effects of benzodiazepines will be increased
***Use the lowest effective dose and be prepared for respiratory depression
*[[Hemodialysis/Hemoperfusion|Hemodialysis]] for very severe toxicity
**Probably not beneficial in patients with normal renal function
*For patients with [[intrathecal pump]]:<ref>Watve SV, et al. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord. 2012 Feb;50(2):107-11. doi: [https://doi.org/10.1038/sc.2011.112 10.1038/sc.2011.112]</ref>
**Consult managing specialist
**Turn off pump
**Can remove baclofen from pump reservoir and replace with normal saline
**Consider large volume CSF removal via [[lumbar puncture]] to reduce level

==Disposition==
*Admit for monitoring until back to neurologic baseline
*ICU for severe coma, seizures, airway compromise, or respiratory failure

==See Also==
*[[Intrathecal drug delivery system complications]]

==External Links==
*[https://emcrit.org/ibcc/baclofen/ Internet Book of Critical Care. Baclofen: therapy, intoxication, & withdrawal]

==References==
<References/>

[[Category:Toxicology]]