Selected Topics: ToxicologyBaclofen and ethanol ingestion: a case report
Introduction
Baclofen [4-amino-3(4-chlorophenyl)-butanoic acid] is a lipid soluble derivative of the neurotransmitter γ-aminobutyric acid (GABA) and appears to act as a pre-synaptic agonist. It is used as a skeletal muscle relaxant for alleviation of symptoms of spasticity associated with various neurologic conditions such as multiple sclerosis and traumatic diseases 1, 2. The drug acts predominantly at the spinal cord level and is rarely associated with severe adverse effects when taken in therapeutic doses. In an overdose, there appears to be prominent central nervous system effects, and the complications are associated with the drug’s neurotransmitter inhibitory action, including respiratory depression, muscle weakness, coma, and seizures 2, 3. We report a case of intentional baclofen overdose with ethanol co-ingestion, the clinical course, treatment, and outcome.
Section snippets
Case report
A 30-year-old woman was brought to the University Hospital Emergency Department (ED) by a friend at 10:30 PM. The friend stated that the patient was depressed about an ongoing evaluation in the neurology clinic for lower extremity weakness, spasms, and tremors that were thought to be due to multiple sclerosis. The woman had been seen in the clinic earlier that day and been prescribed 180 baclofen 10 mg tablets. Approximately 50 min before arrival, the friend’s son had witnessed the patient take
Pharmacology of baclofen
Baclofen is chemically structured as an analog of the naturally occurring neurotransmitter γ-aminobutyric acid (GABA), but because it is more lipophilic, it can readily penetrate the blood-brain barrier (4). The exact mechanism by which baclofen produces its antispasticity effects is unknown, but it is thought to be secondary to the suppression of excitatory neurotransmitter release at certain GABA receptors (5). At the spinal cord level, baclofen has been shown to inhibit both monosynaptic and
Conclusion
We report the case of a patient who presented to the ED after the ingestion of baclofen and ethanol. Her level of consciousness and respiratory efforts deteriorated rapidly. She recovered after supportive care including mechanical ventilation for 36 h. Since coma may occur rapidly after baclofen overdose and the respiratory depression may be exacerbated by the co-ingestion of ethanol, primary importance in the treatment of such ingestions should be placed on maintenance of an airway and
References (26)
- et al.
First-order elimination kinetics following baclofen overdose
Ann Emerg Med
(1986) - et al.
Flumazenil-induced seizures accompanying benzodiazepine and baclofen intoxication
Am J Emerg Med
(1996) - et al.
Atropine in the treatment of baclofen overdose
Am J Emerg Med
(1986) - et al.
Baclofen toxicity in a patient with subclinical renal insufficiency
Arch Phys Med Rehabil
(1994) - et al.
1990 Annual Report of the American Association of Poison Control Centers National Data Collection System
Am J Emerg Med
(1991) - et al.
1991 Annual Report of the American Association of Poison Control Centers National Data Collection System
Am J Emerg Med
(1992) - et al.
1992 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
(1993) - et al.
1993 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
(1994) - et al.
1994 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
(1995) - et al.
1995 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
(1996)
1996 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
1997 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
Baclofen overdose
Postgrad Med J
Cited by (15)
Clinical reasoning: A 41-year-old comatose man with absent brainstem reflexes
2012, NeurologyCitation Excerpt :Ventilatory support (mean length of 40 hours2) is often required, particularly when ingestion exceeds 200 mg.3 Seizures may be related to baclofen toxicity or withdrawal.5 Myoclonus (epileptic or encephalopathic in origin) has been reported.7
Baclofen
2017, Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned PatientA nationwide register-based survey of baclofen toxicity
2015, Basic and Clinical Pharmacology and ToxicologyDeath of an alcohol-dependent patient following intentional drug intoxication: Implication of baclofen?
2014, European Addiction Research