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Signs and symptoms
Prominent features are signs of central nervous depression: somnolence, depressed level of consciousness, respiratory depression due to absent respiratory movement, coma.
Also liable to occur are: confusion, hallucinations, agitation, abnormal electroencephalogram (burst suppression pattern and triphasic waves), accommodation disorders, impaired pupillary reflex; generalised muscular hypotonia, myoclonus, hyporeflexia or areflexia; convulsions; peripheral vasodilatation, hypotension or hyperten sion, bradycardia, tachycardia or cardiac arrhythmias, hypothermia, nausea, vomiting, diarrhoea, salivary hypersecretion; increased hepatic enzymes.
A deterioration in the condition may occur if various substances or drugs acting on the central nervous system (e.g. alcohol, diazepam, tricyclic antidepressants) have been taken at the same time.
Adult patients have ingested up to 1125 mg of baclofen and survived. Ingestion of 1250 to 2500 mg by one patient was fatal. Serious poisoning has occurred with doses of 150 and 300 mg in adults.
No specific antidote is known.
Supportive measures and symptomatic treatment should be given for complications such as hypotension, hypertension, convulsions, gastrointes tinal disturbances, and respiratory or cardiovascular depression.
Symptomatic treatment should include the following:
elimination of the drug from the gastrointestinal tract e.g. administration of activated charcoal; if necessary, saline laxatives
since the drug is excreted chiefly via the kidneys, generous quantities of fluid should be given, possibly together with a diuretic.
measures in support of cardiovascular functions
in the case of respiratory muscle weakness, administration of artificial respiration
in the event of convulsions, diazepam should be administered cautiously i.v., paying attention to increased muscle relaxation and possible respiratory insufficiency, if the patient is not already being artificially ventilated.
Haemodialysis (some times unscheduled) may be useful in severe poisoning associated with renal failure.
Contact the local poisons information centre for advice on management.
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