Lioresal


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baclofen

Apo-Baclofen (CA), Baclofen, Gen-Baclofen (CA), Kemstro, Lioresal, Lioresal Intrathecal, Liotec (CA), Lyflex (UK), Nu-Baclo (CA), PMS-Baclofen (CA)

Pharmacologic class: Skeletal muscle relaxant

Therapeutic class: Antispasmodic

Pregnancy risk category C

FDA Box Warning

• With intrathecal form, abrupt withdrawal may cause high fever, altered mental status, exaggerated rebound spasticity, and muscle rigidity; in rare cases, patient progresses to rhabdomyolysis, multisystem failure, and death. To prevent abrupt withdrawal, pay careful attention to programming and monitoring of infusion system, refill scheduling and procedures, and pump alarms. Advise patients and caregivers of importance of keeping scheduled refill visits, and teach about early drug withdrawal symptoms. Give special attention to patients at apparent risk (those with spinal cord injuries at T6 or above, communication problems, or history of withdrawal symptoms from oral or intrathecal baclofen).

Action

Relaxes muscles by acting specifically at spinal end of upper motor neurons

Availability

Intrathecal injection: 10 mg/20 ml (500 mcg/ml), 10 mg/5 ml (2,000 mcg/ml)

Tablets: 10 mg, 20 mg

Indications and dosages

Reversible spasticity associated with multiple sclerosis or spinal cord lesions

Adults: Initially, 5 mg P.O. t.i.d. May increase by 5 mg q 3 days to a maximum dosage of 80 mg/day.

Children ages 4 and older: 25 to 1,200 mcg/day by intrathecal infusion; (average is 275 mcg/day); dosage determined by response during screening phase.

Severe spasticity in patients who don't respond to or can't tolerate oral baclofen

Adults: Screening phase-Before pump implantation and intrathecal infusion, give test dose to check responsiveness. Administer 1 ml of 50 mcg/ml dilution over 1 minute by barbotage into intrathecal space. Within 4 to 8 hours, muscle spasms should become less severe or frequent and muscle tone should decrease; if patient's response is inadequate, give second test dose of 75 mcg/1.5 ml 24 hours after first dose. If patient is still unresponsive, may give final test dose of 100 mcg/2 ml 24 hours later. Patients unresponsive to 100-mcg dose aren't candidates for intrathecal baclofen. Following appropriate responsiveness, adjust dosage to twice the screening dose and give over 24 hours. If screening dose efficacy is maintained for 12 hours, don't double the dosage. After 24 hours, increase dosage slowly as needed and tolerated by 10% to 30% daily.

Maintenance therapy-During prolonged maintenance therapy, adjust daily dosage by 10% to 40% as needed and tolerated to maintain adequate control of symptoms. Maintenance dosage ranges from 12 mcg to 2,000 mcg daily.

Dosage adjustment

• Renal impairment

• Seizure disorders

• Elderly patients

Off-label uses

• Cerebral palsy

• Tardive dyskinesia

• Trigeminal neuralgia

Contraindications

• Hypersensitivity to drug

• Rheumatic disorders

Precautions

Use cautiously in:

• renal impairment

• epilepsy

• patients who use spasticity to maintain posture and balance

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

• Give oral doses with food or milk.

• Dilute only with sterile, preservative-free sodium chloride for injection.

• Know that intrathecal infusion should be performed only by personnel who have been trained in the procedure.

Adverse reactions

CNS: dizziness, drowsiness, fatigue, confusion, depression, headache, insomnia, hypotonia, difficulty speaking, seizures

CV: edema, hypotension, hypertension, palpitations

EENT: blurred vision, tinnitus, nasal congestion

GI: nausea, vomiting, constipation

GU: urinary frequency, dysuria, erectile dysfunction

Metabolic: hyperglycemia

Skin: pruritus, rash, sweating

Other: weight gain, hypersensitivity reactions

Interactions

Drug-drug. CNS depressants: increased baclofen effect

MAO inhibitors: increased CNS depression, hypotension

Tricyclic antidepressants, drugs causing

CNS depression: hypotonia, increased

CNS depression

Drug-diagnostic tests. Alkaline phosphatase, aspartate aminotransferase, glucose: increased levels

Drug-behaviors. Alcohol use: CNS depression

Patient monitoring

• During intrathecal infusion, check pump often for proper functioning and check catheter for patency.

• Monitor patient's response continually to determine appropriate dosage adjustment.

Observe closely for signs and symptoms of overdose (drowsiness, light-headedness, dizziness, respiratory depression), especially during initial screening and titration. No specific antidote exists. Immediately remove any solution from pump; if patient has respiratory depression, intubate until drug is eliminated.

Patient teaching

• Advise patient to take oral dose with food or milk.

• Instruct patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Caution patient not to discontinue drug therapy abruptly. Doing so may cause hallucinations and rebound spasticity.

• Advise patient to avoid alcohol and other depressants such as sedatives while taking drug.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

baclofen

A GABA (gamma-aminobutyric acid) antagonist used to decrease recalcitrant spinal spasticity in patients with multiple sclerosis, spinal-cord injury and possibly also Parkinson’s disease.
 
Adverse effects
Vomiting, weakness, drowsiness, slow breathing, seizures, coma.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

Lioresal

A brand name for BACLOFEN.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
To date, the clinic has switched all 50 intrathecal pump patients to Gablofen from Lioresal without incident.
Keberle, "The chemistry and kinetics of Lioresal," Postgraduate Medical Journal, vol.
The more common drugs used in the symptomatic treatment of MS Symptom Drug Dosage Fatigue Amantadine (Symmetrel) 100-200 mg, daily (morning) Modafinil (Provigil) 100-400 mg, daily (initially morning and later morning and noon) Fluoxetine (Prozac) 20 mg, in the morning Sertraline (Zoloft) 50 mg, in the morning Venlafaxine (Efexor) 75 mg, in the morning Methylphenidate 10-54 mg, daily (Ritalin, Concerta) Cognition Donepezil (Aricept) 5-10 mg, at night Memantine (Ebixa) 5-10 mg, twice daily Depression Citalopram (Cipramil) 20 mg, in the morning Fluoxetine (Prozac) 20 mg, in the morning Sertraline (Zoloft) 50 mg, in the morning Spasticity Diazepam (Valium) 5-10 mg, at night Baclofen (Lioresal) 10-25 mg, 3 times per day Dantrolene (Dantrium) 25-100 mg, 4 times per day Bladder dysfunction 1.
For example, baclofen (Lioresal) and tizanidine (Zanaflex) are antispasticity medications often prescribed to relieve muscle spasms, cramping and tightness of muscles in MS patients.
The muscle relaxant baclofen (aka Lioresal or Baclo) works as an agonist at presynaptic GABA-B receptors that modulate potassium channels resulting in the suppression of cortico-mesolimbic dopamine system neurons.
Hood, 40, of 125 West Spruce St., Milford, charged with possession of Lioresal Soma, possession of cocaine, and possession of Klonopin, sentenced to three concurrent terms of nine months in the House of Correction, concurrent with another sentence now being served; driving with a suspended license, sentenced to a concurrent term of 10 days in the House of Correction; failing to use care when stopping and refusing to identify himself to police, filed with a guilty finding; and possession of Adderall, dismissed.
Our first-line treatment of choice at present is baclofen (Lioresal) in doses of up to 100 mg daily (25 mg qid) orally.
* Others, such as lioresal (Baclofen), a muscle relaxer, and clarithromycin (Biaxin), an antibiotic.
Plasma and cerebrospinal fluid levels of baclofen (Lioresal) at optimal therapeutic responses in spastic paresis.
* Lioresal (Baclofen), tizanidine (Zanaflex) or a benzodiazepine to reduce muscle spasticity.
According to the guideline, treatment for resistant cases may progress to epidural catheters for sympathetic blockade, spinal cord stimulation, intrathecal baclofen (Lioresal), or sympathectomy.
For these patients, carbamazepine, baclofen (Lioresal), or tizanidine (Zanaflex) may be more effective than other medications, said Dr.