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Drug Name baclofen (bak' loe fen) Apo-Baclofen (CAN), GenBaclofen (CAN), Lioresal, Lioresal Intrathecal Pregnancy Category C Drug class Centrally acting skeletal muscle relaxant

Dosages PO 5 mg 3 times/day for 3 days, increased to 10 mg 3 times/day for 3 days. May further increase if needed. Max: 100 mg/day. Intrathecal Test dose: 25 or 50 mcg. Increase dose by 25 mcg not more often than 24 hrly until 100 mcg/dose to determine appropriate dose. Responders w/ response lasting >812 hr, the test dose that was used to produce the response can be given as a 24-hr infusion; if the response lasted 812 hr, then a dose equivalent to twice the test dose is given. Adjust daily dosage as required. Maintenance: 12 mcg-2 mg/day for spasticity of spinal origin; 22 mcg-1.4 mg/day for spasticity of cerebral origin.

Therapeutic Actions Baclofen is an antispastic. It inhibits both monosynaptic and polysynaptic reflexes at spinal level.

Indications Alleviation of signs and symptoms of spasticity resulting from MS, particularly for the relief of flexor spasms and concomitant pain, clonus, muscular rigidity (for patients with reversible spasticity to aid in restoring residual function); treatment of central spasticity (via SynchroMed pump) Spinal cord injuries and other spinal cord diseases may be of some value Unlabeled uses: Trigeminal neuralgia (tic douloureux); may be beneficial in reducing spasticity in cerebral palsy in children (intrathecal use)

Adverse effects Sedation, drowsiness, ataxia, dizziness, headache, confusion, hallucinations , skin reactions, GI symptoms, enuresis. Potentially Fatal: Respiratory or CV depression, seizures.

Contraindicati ons Hypersensitivi ty. Active peptic ulcer disease.

Nursing considerations Assessment History: Hypersensitivity to baclofen, skeletal muscle spasm resulting from rheumatic disorders, stroke, cerebral palsy, Parkinsons disease, seizure disorders, lactation, pregnancy Physical: Weight; T; skin color, lesions; orientation, affect, reflexes, bilateral grip strength, visual examination; P, BP; bowel sounds, normal GI output, liver evaluation; normal urinary output; LFTs, renal function tests, blood and urine glucose Interventions Patients given implantable device for intrathecal delivery need to learn about the programmable delivery system, frequent checks; how to adjust dose and programming. Give with caution to patients whose spasticity contributes to upright posture or balance in locomotion or whenever spasticity is used to increase function. BLACK BOX WARNING: Taper dosage gradually to prevent hallucinations, possible psychosis, or other serious effects; abrupt discontinuation can cause

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serious reactions. Teaching points Take this drug exactly as prescribed. Do not stop taking this drug without consulting your health care provider; abrupt discontinuation may cause hallucinations or other serious effects. Avoid alcohol, sleep-inducing, or over-the-counter drugs because these could cause dangerous effects. Do not take this drug during pregnancy. If you decide to become pregnant or find that you are pregnant, consult your health care provider. You may experience these side effects: Drowsiness, dizziness, confusion (avoid driving or engaging in activities that require alertness); nausea (eat frequent small meals); insomnia, headache, painful or frequent urination (effects reversible; will go away when the drug is discontinued). Report frequent or painful urination, constipation, nausea, headache, insomnia, or confusion that persists or is severe.

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