Death of an Alcohol-Dependent Patient following Intentional Drug Intoxication: Implication of Baclofen?

Pape, Elise; Roman, Emilie; Scala‐Bertola, Julien; Thivilier, Carine; Javot, Lucie; Saint-Marcoux, Franck; Jouzeau, J.-Y.; Gambier, Nicolas

doi:10.1159/000362409

Cited by 12 publications

(2 citation statements)

References 23 publications

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“…It has been previously found that beyond 150 or 200 mg of baclofen intake, the severity of intoxication may require that the treatment be carried out in intensive care units ( 32 , 52 ). Moreover, anecdotal reports have suggested that baclofen could be a factor of immediate increased risk for death in case of self-poisoning ( 53 ). However, in this case report, baclofen causality was not explored and many other potential factors could actually explain the death of the patient ( 22 ).…”

Section: Adverse Drug Reactions With Unclear Baclofen Causalitymentioning

confidence: 99%

Safety Challenges of Using High Dose Baclofen for Alcohol Use Disorder: A Focused Review

2018

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Since the early 2000s, the gamma-aminobutyric acid type B (GABA-B) receptor agonist baclofen has been extensively used for treating alcohol use disorder (AUD). In some countries, like France, Australia, or Germany, baclofen has been used at patient-tailored dose regimens, which can reach 300 mgpd or even more in some patients. The GABA-B-related pharmacology of baclofen expose patients to a specific profile of neuropsychiatric adverse drug reactions (ADRs), primarily some frequent sedative symptoms whose risk of occurrence and severity are both related to the absolute baclofen dosing and the kinetics of dose variations. Other frequent neuropsychiatric ADRs can occur, i.e., tinnitus, insomnia, or dizziness. More rarely, other serious ADRs have been reported, like seizures, manic symptoms, or sleep apnea. However, real-life AUD patients are also exposed to other sedative drugs, like alcohol of course, but also benzodiazepines, other drugs of abuse, or other sedative medications. Consequently, the occurrence of neuropsychiatric safety issues in these patients is essentially the result of a complex multifactorial exposure, in which baclofen causality is rarely obvious by itself. As a result, the decision of initiating baclofen, as well as the daily dose management should be patient-tailored, according the medical history but also the immediate clinical situation of the patient. The overall safety profile of baclofen, as well as the clinical context in which baclofen is used, have many similarities with the use of opiate substitution medications for opiate use disorder. This empirical statement has many implications on how baclofen should be managed and dosing should be adjusted. Moreover, this constant patient-tailored adjustment can be difficult to adapt in the design of clinical trials, which may explain inconsistent findings in baclofen-related literature on AUD.

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Section: Adverse Drug Reactions With Unclear Baclofen Causalitymentioning

confidence: 99%

Safety Challenges of Using High Dose Baclofen for Alcohol Use Disorder: A Focused Review

2018

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“…However, ingestion of large amounts of baclofen in an attempt to self-arm has been shown to be high-risk. Several reports already insisted on the frequency and severity of baclofen-induced encephalopathy with delirium, seizures, burst suppression on the EEG, leading to mechanical ventilation, aspiration pneumonitis and eventually death [12][13][14][15][16]. Rate of intubation and mechanical ventilation has been reported up to 40 % in a study [17], which is a strong marker of the frequent severity of intoxication.…”

Section: Discussionmentioning

confidence: 99%