Drug withdrawal baclofen

Like many other agents that act at the GABA receptor, abrupt termination of long-term administration of baclofen can result in withdrawal symptoms, even after intrathecal administration (17,18). Patients can present with different sjmptoms, not all of which would be considered classical of drug withdrawal. 

Baclofen is at least as effective as diazepam in reducing spasticity and causes less sedation. In addition, baclofen does not reduce overall muscle strength as much as dantrolene. It is rapidly and completely absorbed after oral administration and has a plasma half-life of 3-4 hours. Dosage is started at 15 mg twice daily, increasing as tolerated to 100 mg daily. Adverse effects of this drug include drowsiness however, patients become tolerant to the sedative effect with chronic administration. Increased seizure activity has been reported in epileptic patients. Therefore, withdrawal from baclofen must be done very slowly. 

Dantrolene is life-saving in mahgnant hyperthermia associated with volatile anesthetics and suxamethonium and is also the drug of choice for the treatment of neuroleptic mahgnant syndrome. Dantrolene has therefore been suggested as an additional therapeutic option in baclofen withdrawal (18), but there is only limited experience (24). In one case of baclofen withdrawal, dantrolene was given with success (24). 

Ratnayaka BD, DhaUwal H, Watkin S. Drug points. Neonatal convulsions after withdrawal of baclofen. BMJ 2001 323(7304) 85. 

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. 

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