Baclofen Safety, Toxicity, Withdrawal, and Overdose

Baclofen is a proven and effective agent for the management of spasticity. Its use has recently expanded to the off-label treatment of several other diseases. It is important for providers to be aware of baclofen’s unique safety profile, dosing considerations, and potential complications. Both oral and intrathecal baclofen administration can be associated with life-threatening toxicity and withdrawal. The management of baclofen toxicity includes immediate discontinuation of baclofen from all sources and supportive care based on symptom management. The treatment of baclofen withdrawal includes reinitiation or supplementation of baclofen therapy along with the administration of adjunctive pharmacological agents to treat associated withdrawal symptoms. Examples of adjunctive treatment options for the management of baclofen withdrawal include benzodiazepines, cyproheptadine, propofol, dantrolene, dexmedetomidine, and tizanidine. Because both baclofen toxicity and withdrawal have the potential for rapid progression and severe clinical decompensation, providers must maintain a high index of suspicion to establish a timely diagnosis and prevent morbidity and mortality.