Background The number of baclofen prescriptions have increased steadily over the last decade, and published case reports have demonstrated the potential of this agent to cause significant CNS toxicity including prolonged coma mimicking brain death. To date, there is only limited data investigating baclofen exposures on a nationwide scale in the United States. This study aims to describe the incidence and characteristics of baclofen exposures reported to United States poison control centers (PCCs) from 2000 – 2017.
Methods National Poison Database System (NPDS) records were reviewed for all baclofen exposures from 2000 – 2017. Cases classified as “exposure” that included baclofen as a coded substance were included. For all exposures, demographic and clinical information was collected. For single-substance exposures to baclofen alone, specific information regarding treatments and clinical effects was collected.
Results 45,355 exposures to baclofen were reported to US PCCs from 2000 – 2017. The median patient age was 38 years, and 58.7% of exposures involved female patients. The average increase in reported exposures per year was 11.8%, primarily due to significant yearly increases in intentional-suspected suicide exposures. Seventy-nine percent of all exposures were managed in a healthcare facility, and 46.8% of these were managed in a critical care unit. In total, 20,609 exposures were to baclofen alone, and the primary clinical effects observed in these cases were drowsiness/lethargy (41.0% of exposures), confusion (13.65), bradycardia (11.4%), and coma (10.7%). The most commonly utilized therapies (and percentage of exposures in which they were utilized) were IV fluids (30.3%), oxygen (19.1%), intubation (14.1%), ventilation (13.0%), and benzodiazepines (10.5%).
Conclusions The rate of exposures to baclofen reported to US PCCs increased significantly during the study period, and this increase was largely driven by intentional-suspected suicide exposures. This may reflect an increased usage of the medication in patients at increased risk of self-harm. With nearly 4/5 of cases requiring care in a healthcare facility, and nearly 50% of those cases requiring admission into a critical care unit, this study suggests that baclofen exposures can cause significant toxicity and healthcare utilization.Published in