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 makes Baclofen more effective in treating spasticity at the level of the spinal cord. In addition, Baclofen does not cause the type of generalized muscle weakness 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.
