Withdrawal Effects of Baclofen
Abrupt discontinuation of baclofen can lead to potentially life-threatening withdrawal symptoms, particularly in patients on long-term therapy, and requires careful tapering to prevent serious complications. 1
Common Withdrawal Symptoms
- Visual and auditory hallucinations 1
- Anxiety and agitation 1
- Delirium 1
- Fever/hyperthermia 1, 2
- Tremors 1, 3
- Tachycardia 1, 4
- Seizures 1, 2
- Rebound spasticity 1
Severe Withdrawal Complications
- Altered mental status 1
- Muscle rigidity leading to rhabdomyolysis 1, 3
- Disseminated intravascular coagulation 5
- Multiorgan failure 1, 5
- Hypotension or hypertension 4
- Death (particularly with intrathecal baclofen) 1
Risk Factors for Severe Withdrawal
- Intrathecal administration (higher risk than oral) 1, 5
- Long-term use 2
- Higher doses 6
- Abrupt discontinuation 1
- Programming errors in intrathecal pumps 5
Timing of Withdrawal Symptoms
- Symptoms typically develop within 1-3 days after abrupt cessation 3
- For intrathecal baclofen, withdrawal can evolve over 1-3 days but may become fulminant if not recognized promptly 1
- In severe cases, withdrawal syndrome can last for over a week if untreated 2
Differential Diagnosis
Baclofen withdrawal can mimic other serious conditions, including:
- Sepsis 4
- Meningitis 4, 3
- Autonomic dysreflexia 4
- Malignant hyperthermia 4
- Neuroleptic malignant syndrome 4, 3
- Seizure disorders 3
Management of Baclofen Withdrawal
- Immediate recognition of the syndrome is critical 5
- Reinstitution of baclofen therapy is the primary treatment 1, 2, 5
- High-dose benzodiazepines are effective for symptom management 5, 4
- Intensive care management for severe cases 5
- For intrathecal pump issues, prompt analysis and repair of the pump 5
- For infected pumps requiring removal, consider externalized pump for gradual weaning 6
Prevention
- Patient and caregiver education about withdrawal risks 5
- Regular check-up of intrathecal baclofen pumps 5
- Gradual dose reduction when discontinuing therapy 1, 7
- For pregnant patients on baclofen, gradually reduce dose before delivery to prevent neonatal withdrawal 7
Special Considerations
- Oral baclofen replacement may not effectively prevent or treat intrathecal baclofen withdrawal syndrome 5
- In perioperative settings, baclofen should be continued including on the day of operation to avoid withdrawal 1
- For patients with infected pumps, externalization of the pump for gradual weaning (20-50% per day) has been shown effective in preventing withdrawal 6