Baclofen Dosing for Central Fever in Pediatrics
The recommended starting dose of baclofen for pediatric patients with central fever is 5 mg once daily, with gradual titration up to 20 mg per day as needed to control fever. 1
Dosing Recommendations
- Start with baclofen 5 mg once daily as an initial dose for pediatric patients with central fever 1
- Gradually increase the dose until fever control is achieved, with effective doses reported at 20 mg per day in pediatric patients 1
- For adults with central hyperthermia, higher doses of 30-60 mg/day divided into multiple doses may be required 2
- Baclofen can be administered orally in tablet form or as a compounded powder (10 mg/g) for pediatric patients who cannot swallow tablets 3
Diagnostic Considerations
- Central fever should be considered as a diagnosis of exclusion after ruling out infectious causes and aseptic meningitis 1
- Central fever is particularly common after neurosurgical procedures such as hemispherectomy or functional hemispherotomy 1
- Central hyperthermia may result from damage to thermoregulatory pathways in the brainstem 2
- Patients with central fever typically do not respond to conventional antipyretics or antibiotics 1, 2
Monitoring and Follow-up
- Monitor body temperature regularly to assess response to baclofen therapy 1, 2
- Assess for clinical improvement within 24-48 hours of dose adjustments 1
- Continue baclofen therapy as long as needed to maintain normal body temperature 1
- Be aware that abrupt discontinuation of baclofen may lead to withdrawal symptoms, so tapering is recommended when discontinuing 4
Special Considerations
- For patients who fail to respond to oral baclofen or require long-term therapy, intrathecal baclofen may be considered in specialized settings 4
- For pediatric patients who cannot swallow tablets, a compounded oral powder formulation of baclofen (10 mg/g) has been shown to be stable for up to 120 days when properly stored 3
- When compounding baclofen for pediatric use, the stability of the medication should be ensured by proper storage in amber bottles with desiccant or appropriate laminated packaging 3
Clinical Pearls
- Baclofen is a GABA receptor agonist that appears to effectively control central fever through mechanisms that may involve thermoregulatory pathways 1, 2
- Using baclofen for central fever can help avoid unnecessary antibiotic use in patients with non-infectious fever 1
- Response to baclofen therapy can be a diagnostic indicator confirming the central origin of fever 1, 2
- The use of baclofen for central fever is an off-label indication but has shown efficacy in case reports 1, 2