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here is all the info on the drug he should be careful because the withdrawal symptoms are dangerous. he should stay out of his parents medicine cabinet. take care
Pronunciation
BAK-loe-fen [Audio]
Trade Name(s)
• Kemstro
• Lioresal
Pregnancy Category
Category C
Ther. class.
antispasticity agents
skeletal muscle relaxants
(centrally acting)
Indications
• PO: Treatment of reversible spasticity due to multiple sclerosis or spinal cord lesions
• IT: Treatment of severe spasticity originating in the spinal cord
Unlabelled Use(s):
Management of pain in trigeminal neuralgia
Action
Inhibits reflexes at the spinal level
Therapeutic Effect(s):
Decreased muscle spasticity; bowel and bladder function may also be improved
Pharmacokinetics
Absorption: Well absorbed after oral administration
Distribution: Widely distributed; crosses the placenta
Metabolism and Excretion: 70–80% eliminated unchanged by the kidneys
Half-life: 2.5–4 hr
TIME/ACTION PROFILE (effects on spasticity)
ROUTEONSET PEAKDURATION
POhrs–wks unknownunknown
IT0.5–1 hr4 hr4–8 hr
Contraindication/Precautions
Contraindicated in:
• Hypersensitivity
• Orally-disintegrating tablets contain aspartame and should not be used in patients with phenylketonuria
Use Cautiously in:
• Patients in whom spasticity maintains posture and balance
• Patients with epilepsy (may J seizure threshold)
• Renal impairment (J dose may be required)
• OB: Lactation: Pedi: Safety not established
• Geri: Geriatric patients are at I risk of CNS side effects
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.
Metabolic: hyperglycemia, weight gain.
Neuro: ataxia.
Misc: hypersensitivity reactions, sweating.
*CAPITALS indicates life-threatening.
*italic indicates most frequent.
Interactions
Drug-Drug
• I CNS depression with other CNS depressants including alcohol , antihistamines , opioid analgesics , and sedative/hypnotics
• Use with MAO inhibitors may lead to I CNS depression or hypotension
Drug-Natural Products
Concomitant use of kava , valerian , or chamomile can I CNS depression
Route/Dosage
• PO (Adults): 5 mg 3 times daily. May increase q 3 days by 5 mg/dose up to 80 mg/day (some patients may have a better response to 4 divided doses).
• IT (Adults): 100–800 mcg/day infusion; dose is determined by response during screening phase.
• IT (Children): 25–1200 mcg/day infusion (average 275 mcg/day); dose is determined by response during screening phase.
Availability
• Tablets: 10 mg, 20 mg
» Cost:
Generic: 10 mg $78.16/270, 20 mg $137.92/270.
• Orally-disintegrating tablets (Kemstro) (orange): 10 mg, 20 mg
• Intrathecal injection: 50 mcg/ml, 500 mcg/ml, 2000 mcg/ml
Assessment
• Assess muscle spasticity before and periodically during therapy
» Observe patient for drowsiness, dizziness, or ataxia. May be alleviated by a change in dose
IT
• Monitor patient closely during test dose and titration. Resuscitative equipment should be immediately available for life-threatening or intolerable side effects
Lab Test Considerations
• May cause I in serum glucose, alkaline phosphatase, AST, and ALT levels
Potential Nursing Diagnoses
• Impaired wheelchair mobility (Indications)
• Risk for injury (Adverse Reaction)
Implementation
• PO: Administer with milk or food to minimize gastric irritation
» For orally disintegrating tablets, just prior to administration place tablet on tongue with dry hands. Tablet will disintegrate, then swallow with saliva or water. Administration with liquid is not necessary
• IT: For screening phase, dilute for a concentration of 50 mcg/ml with sterile preservative-free NaCl for injection. Test dose should be administered over at least 1 min. Observe patient for a significant decrease in muscle tone or frequency or severity of spasm. If response is inadequate, 2 additional test doses, each 24 hr apart, 75 mcg/1.5 ml and 100 mcg/2 ml respectively, may be administered. Patients with an inadequate response should not receive chronic IT therapy
» Dose titration for implantable IT pumps is based on patient response. If no substantive response after dose increase, check pump function and catheter patency
Patient/Family Teaching
• Instruct patient to take baclofen as directed. Take a missed dose within 1 hr; do not double doses. Caution patient to avoid abrupt withdrawal of this medication because it may precipitate an acute withdrawal reaction (hallucinations, increased spasticity, seizures, mental changes, restlessness). Discontinue baclofen gradually over 2 wk or more
• May cause dizziness and drowsiness. Advise patient to avoid driving or other activities req
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