Baclofen Opioids

Opioids, benzodiazepines, barbiturates, corticosteroids, dopamine agonists (e.g., amantadine, bromocriptine, levodopa, pergolide, pramipexole, ropinirole), H2-receptor antagonists, anticholinergics (e.g., diphenhydramine, trihexylphenidyl), P-adrenergic blockers, clonidine, methyldopa, carbamazepine, phenytoin, baclofen, cyclobenzaprine, lithium, antidepressants (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors), and interleukin-2... 

However, because a continuous infusion is required, implantable pumps containing a very concentrated solution of baclofen are used to avoid frequent refills. Inadvertent subarachnoid bolus administration of a concentrated solution will produce cranial spread of baclofen within the CSF, resulting in cerebral effects. This is most hkely to occur when a new catheter or pump is implanted or during surgical revision of a catheter or implantable pump in cases of malfunction. A report of coma after implantation of a baclofen pump in five out of nine consecutive children illustrates this (3). The authors suggested that these children should be monitored in the recovery room for 5 hours postoperatively, in order to cover both the peak effect of any baclofen bolus and the additive effects of other perioperative CNS suppressants, such as opioids, benzodiazepines, or sedative antiemetics. In another report of transient coma after perioperative intrathecal bolus administration it was shown that the management of this complication can require admission to an intensive care unit (4). 

Answer B. Buspirone has selective anxiolytic activity that is slow in onset The drug has no abuse liability and will not suppress withdrawal symptoms in patients who have become physically dependent on barbiturates, benzodiazepines, or ethanol. Bupropion is an antidepressant, also approved for management of dependence on nicotine. Baclofen is a spinal cord muscle relaxant that activates GABAfi receptors. Buprenorphine is a long-acting opioid analgesic with no effectiveness in GAD, and butabarbital is a barbiturate that may cause dependence. 

Rose MJ, Wang C, Golder FJ, Hammond JA, Bolser DC (2004) Influence of intrathecal and intraarterial baclofen on laryngeal and tracheobronchial cough in the cat. FASEB J 18 A718 Schomburg ED, Steffens H (1995) Influence of opioids and naloxone on rhythmic motor activity in spinal cats, Exp Brain Res 103 333-343... 

The manufacturer of baclofen warns that increased sedation may occur if baclofen is taken with synthetic opioids and that the risk of respiratory depression is also increased. Careful monitoring of respiratory and cardiovascular functions is essential. ... 

Oral baclofen, in daily divided doses of 15 to 80 mg, has been found to be effective in treating neiu-opathic pain it has been used alone and as an adjuvant for the treatment of trigeminal neuralgia. Oral baclofen, in similar doses, has been used to treat intractable hiccups. In addition, though not a conventional analgesic itself, it may potentiate opioid analgesia. Continuous intrathecal baclofen infusion of 1 to 2 mg daily for the management of tetanus has been reported. 

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