Baclofen Intrathecal Pump

Aka: Baclofen Intrathecal Pump, Baclofen, Lioresal, Baclofen Pump

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II. Indications

  1. Severe Muscle spasticity (e.g. Spinal Cord Injury, Cerebral Palsy, Multiple Sclerosis)
  2. Alcohol Withdrawal

III. Pharmacology

  1. Baclofen is a Skeletal Muscle Relaxant that binds GABA B receptors
    1. Baclofen hyperpolarizes afferent nerve fibers
      1. Blocks presynaptic Calcium influx
      2. Blocks presynaptic Potassium efflux
    2. Inhibits spinal cord reflexes
    3. Reduces Muscle spasticity
  2. Oral Baclofen does not cross blood brain barrier well
    1. Requires intolerable oral doses to offer effect
  3. Instead, Baclofen is typically used via Baclofen Intrathecal Pump
    1. Intrathecal Baclofen has fewer side effects and may be used at low dose

IV. Dosing

  1. Baclofen 50-100 mcg/day via Intrathecal Pump (up to 900 mcg) and slowly titrate to effect
  2. Small dose modifications can have significant effects on patient findings (due to direct CSF drug delivery)
  3. Taper off over 1-2 weeks (risk of Hallucinations, Seizures if abruptly stopped)
    1. See Baclofen Withdrawal

V. Complications

  1. Baclofen Withdrawal
  2. Baclofen Toxicity

VI. References

  1. Riley and LoVecchio (2021) Crit Dec Emerg Med 35(5):28

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