Baclofen toxicity: Difference between revisions
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==Background==
==Background==
*Baclofen is a synthetic derivative of GABA that can be used for conditions such as multiple sclerosis or muscle spasticity
[[File:BACLOFEN.jpeg|thumb|Tablets of Baclofen]]
*At therapeutic doses, Baclofen acts as a GABA-B receptor agonist
[[File:Baclofen.svg|thumb]]
*At higher doses, Baclofen loses selectivity and can cause sedation
*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>
*Primary excreted by the kidneys
**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==
==Clinical Features==
*Nausea and vomiting
*[[Nausea and vomiting]]
*Drowsziness
*[[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
*[[Delirium]]
*Seizures
*[[Seizures]]
*Coma
**Tonic-clonic
*Respiratory compromise
**Non-convulsive status epilepticus
*Hypothermia
*Myoclonus
*Airway compromise and [[respiratory failure]]
*[[Hypothermia]]
*[[Hypotension]]
*[[Bradycardia]] and conduction abnormalities


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


==Evaluation==
==Evaluation==
*Diagnosis of exclusion
*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==
==Management==
*Activated charcoal for recent ingestion
*[[Activated charcoal]] for recent ingestion
*Supportive care:
*Supportive care:
**IV fluids, respiratory 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>
**Vasopressors for persistent hypotension
**[[IV fluids]]
**Benzodiazepines for seizures
**[[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
*[[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==
==Disposition==
 
*Admit for monitoring until back to neurologic baseline
*ICU for severe coma, seizures, airway compromise, or respiratory failure


==See Also==
==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==
<References/>
<References/>
*Jung, M. “Baclofen Overdoses”. Maryland Poison Center, University of Maryland School of Pharmacy. www.mdpoison.com Accessed April 29th, 2014.
*Nicola Y Leung, Ian M Whyte, Geoffrey K Isbister Baclofen overdose: defining the spectrum of toxicity. Emerg Med Australas: 2006, 18(1);77-82


[[Category:Toxicology]]
[[Category:Toxicology]]

Latest revision as of 18:19, 5 November 2025

Background

Tablets of Baclofen
Baclofen.svg
  • 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.[1]
  • 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 m2.
    • Patients on chronic therapy may become toxic with new AKI.

Clinical Features

Differential Diagnosis

Sedative/hypnotic toxicity

Also consider co-ingestion with intentional overdose

Evaluation

  • Diagnosis of exclusion, based on history
    • Baclofen level can be measured but is not clinically useful
  • In patients with 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[3]
    • 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 for very severe toxicity
    • Probably not beneficial in patients with normal renal function
  • For patients with intrathecal pump:[4]
    • 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

External Links

References

  1. ↑ Jung, M. “Baclofen Overdoses”. Maryland Poison Center, University of Maryland School of Pharmacy. www.mdpoison.com Accessed April 29th, 2014.
  2. ↑ Nicola Y Leung, Ian M Whyte, Geoffrey K Isbister Baclofen overdose: defining the spectrum of toxicity. Emerg Med Australas: 2006, 18(1);77-82
  3. ↑ *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.
  4. ↑ Watve SV, et al. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord. 2012 Feb;50(2):107-11. doi: 10.1038/sc.2011.112
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