Baclofen

INTRODUCTION

Indications

PO: Treatment of reversible spasticity due to multiple sclerosis or spinal cord lesions. Intrathecal: Treatment of severe spasticity originating in the spinal cord. Unlabeled Use: Management of pain in trigeminal neuralgia.

Action

Inhibits reflexes at the spinal level. Therapeutic Effects: Decreased muscle spasticity; bowel and bladder function may also be improved.

Adverse Reactions/Side Effects

CNS: SEIZURES (IT), dizziness, drowsiness, fatigue, weakness, confusion, depression, headache, insomnia. EENT: nasal congestion, tinnitus. CV: edema, hypotension. GI: nausea, constipation. GU: frequency. Derm: pruritus, rash. Metab: hyperglycemia, weight gain. Neuro: ataxia. Misc: hypersensitivity reactions, sweating.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially during intrathecal (spinal) administration. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Assess patient's spasticity, ROM, functional ability, and posture (e.g., head control and trunk stability), especially when beginning baclofen treatment or during dose adjustments. Communicate with physician, family/caregivers, and other health professionals to determine if dosage is helping achieve desired functional outcomes.

• During intrathecal administration:

  • Monitor patient closely during initial (test) doses and titration. Resuscitative equipment should be immediately available for life-threatening or intolerable side effects.

  • Monitor sudden changes in spasticity, muscle strength, or CNS symptoms (confusion, somnolence, agitation, hallucinations) that might indicate pump malfunction.

  • Make sure patient and caregivers understand how to protect the pump and catheter, and adhere to an appropriate schedule for pump refills.

• Assess dizziness, drowsiness, and ataxia that might affect gait, balance, transfers, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Monitor changes in mood and behavior including confusion and depression. Report these changes to the physician.

• If treating trigeminal neuralgia, use appropriate pain scales (visual analogue scales, others) to document whether this drug is ...