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Thread: sudden baclofen withdrawal ... help

  1. #1
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    sudden baclofen withdrawal ... help

    My son C3/4 complete was admitted to hospital 3 days ago with a bowel obstruction. He was throwing up brown vile. The hospital put in a NG tube so he is having nothing by mouth.
    He has been taking 80 mgs of Baclophen for 13 years. With the NG tube his meds have been
    stopped. Yesterday he started severly hallucinating. The Dr. said they can not give him
    baclophen and they are managing this with the drug virtec.
    My question is how long will this withdrawal last and what else can I expect to have happen.
    Im asking here because he is in a regulare ICU hospital unit, not a spinal cord unit and I dont think the Dr. is very familiar with spinal cord injury.

  2. #2
    Hi,

    I'm wondering why they cannot give baclofen. It can be given through the NG tube in the same way his other meds are given. baclofen withdrawal is a very serious thing.

    AAD

  3. #3
    We talked about this same issue here in the past year or two. Not sure about Canada but injectable Baclofen is not readily available in the states. I am not a surgeon and I realize he is to have nothing by mouth as he has a bowel obstruction but would mixing baclofen in 30 ml of water really be an issue? I don't know the answer to that question.

    Having said that Balcofen withdrawal can be life threatening and there really are limited medications that can help. Benzodiazepines may help somewhat but they focus on GABA A receptors where Baclofen does GABA B. GHB also does GABA B but may be hard to get.

    The final solution would be to find a compounding pharmacy and have them make Baclofen in a suppository form.

  4. #4
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    His hallucinations and angxiety became so out of control for him, they have sedated him now. It has now been 4 days without his meds. My real concern is how long can it take for the withdrawl of his meds to be through. I know it would be different in everyone but there should be a minimum and maximum lenghth of time and i cannot find that answer on line looking into bacolphen withdrawal.
    As for giving him the meds with a little water they absolutly refused anything by mouth because of his bowel.

  5. #5
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    Last time is was hospitalized, my roomie (who had MS) had a bowel obstruction, and they gave him his meds with water, figuring that he would absorb some of it before vomiting it back up. It seemed to work.
    Don - Grad Student Emeritus
    T3 ASIA A 26 years post injury

  6. #6
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    Quote Originally Posted by noryn View Post
    The final solution would be to find a compounding pharmacy and have them make Baclofen in a suppository form.
    No,

    Kriel RL, Krach LE, Hoff DS et al. Failure of absorption of baclofen after rectal administration. Pediatr Neurol 1997; 16 (4): 351-2.

    Considering the amount of saliva we produce and swallow each day (750 ml to 2000 ml), I don't understand why they don't give the baclofen, you have to choose the less dangerous option ...
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

  7. #7
    Quote Originally Posted by NancyR View Post
    His hallucinations and angxiety became so out of control for him, they have sedated him now. It has now been 4 days without his meds. My real concern is how long can it take for the withdrawl of his meds to be through. I know it would be different in everyone but there should be a minimum and maximum lenghth of time and i cannot find that answer on line looking into bacolphen withdrawal.
    As for giving him the meds with a little water they absolutly refused anything by mouth because of his bowel.
    I cannot seem to find an exact length of time either but have read a few case reports of withdrawal lasting more than a week.

    I understand their concern with the bowel but do they also realize that the Baclofen withdrawal can be life threatening as well?

  8. #8
    Quote Originally Posted by JGNI View Post
    No,

    Kriel RL, Krach LE, Hoff DS et al. Failure of absorption of baclofen after rectal administration. Pediatr Neurol 1997; 16 (4): 351-2.

    Considering the amount of saliva we produce and swallow each day (750 ml to 2000 ml), I don't understand why they don't give the baclofen, you have to choose the less dangerous option ...
    That is very interesting. Why do they compound it in suppository form then? Is there a difference in the solution that could affect absorption? We discussed this about 2 years ago in another thread. I was under the impression rectal use may be of some benefit but will have to change that now.

    I am not wanting to "second guess" the doctor but I also agree with you. It seems like mixing this in just a small amount of water wouldn't be that big of an issue. Again I am not a gastrointestinal specialist.

  9. #9
    Nancy, is your son on the spinal unit at VGH? Can he be moved there?

  10. #10
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    Quote Originally Posted by noryn View Post
    That is very interesting. Why do they compound it in suppository form then? Is there a difference in the solution that could affect absorption? We discussed this about 2 years ago in another thread. I was under the impression rectal use may be of some benefit but will have to change that now.

    I am not wanting to "second guess" the doctor but I also agree with you. It seems like mixing this in just a small amount of water wouldn't be that big of an issue. Again I am not a gastrointestinal specialist.
    Here is the discussion you participated in:

    http://sci.rutgers.edu/forum/archive.../t-102370.html

    I have never compounded suppositories but I think that they are useful for a "local" effect in conditions like spasmodic vaginismus.

    On the other hand, the study I quoted tested it in an aqueous base, so maybe the use of another vehicle could give better results but I am not convinced.
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

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