Baclofen in the Treatment of Spinal Cord Injuries
Baclofen
Baclofen, commonly known as Kemstro or Lioresal, acts as an allosteric modulator to GABA b receptors. This leads to the inhibition of alpha motor neurons within the spinal cord. Pre- and postsynaptic inhibition leads to reduction in skeletal muscle tone. [1][2] Weak permeability to the blood-brain barrier marks Baclofen as more effective treating spasticity at the level of the spinal cord. In addition, Baclofen does not cause generalized muscle weakness as seen with dantrolene.[2]
Intrathecal administration utilizes a surgically implanted catheter connected to a pump that delivers the drug into the subarachnoid space, around the level of the lesion, allowing for higher efficacy through smaller dosages. Initial adult dose is 5 mg and increased by 5 mg at 72-hour intervals, up to 80 mg/day [1]. There is no specific pediatric dose, the dose is calculated by the child’s size and weight. The half-life ranges between 2.5-4 hours, and the rate of clearances is 4-8 hours according to the patient's metabolic rate. Main adverse effects to look for are nausea, dizziness, drowsiness, fatigue, and weakness[1][2].
Monitoring medication specific CNS symptoms such as seizures and nausea as they are prevalent. Similar to benzodiazepines withdrawal symptoms are a byproduct of discontinuing the drug[2]. Scheduling the therapy sessions according to the drug therapeutic index is necessary as baclofen acts as an alternative to other sedative-hypnotics [1][2]. In IT patients pump placement and overall knowledge of the pump is important to ensure safety through interventions.
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- ↑ 1.0 1.1 1.2 1.3 Ciccone, C. D. (2016). Pharmacology in rehabilitation (5th ed.). Philadelphia: F.A. Davis Company.
- ↑ 2.0 2.1 2.2 2.3 2.4 Shukla, Lekhansh, et al. “Baclofen in the Short-Term Maintenance Treatment of Benzodiazepine Dependence.” Journal of Neurosciences in Rural Practice, vol. 5, no. 5, 2014, p. 53., doi:10.4103/0976-3147.145203.
