OVERDOSE
Tablets
Signs and Symptoms: Vomiting, muscular
hypotonia, drowsiness, accommodation disorders, coma,
respiratory depression, and seizures.
Treatment: In the alert patient, empty
the stomach promptly by induced emesis followed by lavage.
In the obtunded patient, secure the airway with a cuffed
endotracheal t.b. before beginning lavage (do not induce
emesis). Maintain adequate respiratory exchange, do not
use respiratory stimulants.
Injection
Special attention must be given to recognizing the signs
and symptoms of overdosage, especially during the initial
screening and dose-titration phase of treatment, but also
during re-introduction of baclofen injection after a period
of interruption in therapy.
Symptoms of Baclofen Injection Overdose
Drowsiness, lightheadedness, dizziness, somnolence, respiratory
depression, seizures, rostral progression of hypotonia
and loss of consciousness progressing to coma of up to
24-hr duration. In all seven cases reported, coma was
reversible without sequelae after infusion was stopped.
Symptoms of baclofen injection overdose were reported
in a sensitive adult patient after receiving a 25 mcg
intrathecal bolus.
Treatment Suggestions for Overdose
There is no specific antidote for treating overdoses of
baclofen injection; however, the following steps should
ordinarily be undertaken:
Residual baclofen injection solution should be removed
from the pump as soon as possible.
Patients with respiratory depression should be intubated
if necessary, until the drug is eliminated.
Anecdotal reports suggest that intravenous physostigmine
may reverse central side effects, notably drowsiness and
respiratory depression. Caution in administering physostigmine
intravenously is advised, however, because its use has
been associated with the induction of seizures, bradycardia,
cardiac conduction disturbances.
Physostigmine Doses for Adult Patients:
A total dose of 1-2 mg physostigmine may be tried intravenously
over 5-10 minutes. Patients should be monitored closely
during this time. Repeat doses of 1 mg may be administered
at 30-60 minute intervals in an attempt to maintain adequate
respiration and alertness if the patient shows a positive
response.
Physostigmine Doses for Pediatric Patients:
Administer 0.02 mg/kg physostigmine intravenously, do
not give more than 0.5 mg per minute. The dosage may be
repeated at 5 to 10 minute intervals until a therapeutic
effect is obtained or a maximum dose of 2 mg is attained.
Physostigmine may not be effective in reversing large
overdoses and patients may need to be maintained with
respiratory support.
If lumbar puncture is not contraindicated, consideration
should be given to withdrawing 30-40 ml of CSF to reduce
CSF baclofen concentration.
CONTRAINDICATIONS
Tablets and Injection
Hypersensitivity to baclofen.
Injection
Hypersensitivity to baclofen. Baclofen injection is not
recommended for intravenous, intramuscular, or epidural
administration
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