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Mousigian MA, Rosenblum SA, Neil Knierbein EE, Daunter AK. Neonatal baclofen withdrawal following intrauterine exposure. J Pediatr Rehabil Med 2022; 15:389-394. [PMID: 35094999 DOI: 10.3233/prm-210023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnant women with spinal cord injuries are often advised to continue oral baclofen during pregnancy to manage spasticity, though the potential for adverse events in neonates is not well understood. OBJECTIVE Here, a case is described in which a male neonate with intrauterine baclofen exposure, born at 34 3/7 weeks via Cesarean section, demonstrated a two-minute episode of extensor posturing at fifteen minutes of life possibly concerning for baclofen withdrawal. His mother had taken baclofen 30 milligrams orally four times per day throughout pregnancy for management of spasticity associated with a remote cervical spinal cord injury. Due to concern for possible withdrawal, the neonate was started on a baclofen taper beginning within hours of birth while evaluation for alterative etiologies was underway. Symptoms were monitored using the Finnegan Neonatal Abstinence Scale. The neonate tolerated the baclofen taper well and was successfully tapered off by the fourteenth day of life with full resolution of symptoms and no apparent neurologic deficits. CONCLUSION Further research is needed to assess the incidence of neonatal baclofen withdrawal with regard to maternal dosage and route of administration, and to determine the most appropriate monitoring and management protocols for the neonate.
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Affiliation(s)
- Marianne A Mousigian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Sara A Rosenblum
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Erin E Neil Knierbein
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Alecia K Daunter
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Romito JW, Turner ER, Rosener JA, Coldiron L, Udipi A, Nohrn L, Tausiani J, Romito BT. Baclofen therapeutics, toxicity, and withdrawal: A narrative review. SAGE Open Med 2021; 9:20503121211022197. [PMID: 34158937 PMCID: PMC8182184 DOI: 10.1177/20503121211022197] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
Baclofen is an effective therapeutic for the treatment of spasticity related to multiple sclerosis, spinal cord injuries, and other spinal cord pathologies. It has been increasingly used off-label for the management of several disorders, including musculoskeletal pain, gastroesophageal reflux disease, and alcohol use disorder. Baclofen therapy is associated with potential complications, including life-threatening toxicity and withdrawal syndrome. These disorders require prompt recognition and a high index of suspicion. While these complications can develop following administration of either oral or intrathecal baclofen, the risk is greater with the intrathecal route. The management of baclofen toxicity is largely supportive while baclofen withdrawal syndrome is most effectively treated with re-initiation or supplementation of baclofen dosing. Administration of other pharmacologic adjuncts may be required to effectively treat associated withdrawal symptoms. This narrative review provides an overview of the historical and emerging uses of baclofen, offers practical dosing recommendations for both oral and intrathecal routes of administration, and reviews the diagnosis and management of both baclofen toxicity and withdrawal.
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Affiliation(s)
- Jia W Romito
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
- Department of Neurological Surgery, The
University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, The University
of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily R Turner
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - John A Rosener
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Landon Coldiron
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Ashutosh Udipi
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Linsey Nohrn
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Jacob Tausiani
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Bryan T Romito
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
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Balakirouchenane D, Khoudour N, Chouchana L, Chevillard L, Parat S, Declèves X. Pharmacokinetics of Baclofen in a Full-Term Newborn after Intrauterine Exposure: A Case Report. Neonatology 2021; 118:624-627. [PMID: 34569533 DOI: 10.1159/000518657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
Intrauterine exposure to baclofen can lead to syndrome of withdrawal during the first days of the newborn. We report the case of a full-term baby exposed to baclofen during pregnancy. The mother was treated with baclofen 10 mg 4 times daily. Blood samples were collected from the mother before entering labor and from the baby at H0, H11, H31, and H102 after birth to measure baclofen concentrations and monitor its elimination. Baclofen maternal and neonate pharmacokinetics (PK) and placental transfer were assessed using a physiologically based PK model. Baclofen PK in the neonate after birth followed a monoexponential elimination with a half-life of 10 h, 3-fold longer than that in adults. The newborn was monitored for 11 days without experiencing any symptoms of withdrawal. Reducing baclofen dosing regimen of the mother to the lowest and therefore reducing fetal exposure to baclofen is essential. This case reports for the first time the baclofen pharmacokinetic profile in a newborn.
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Affiliation(s)
- David Balakirouchenane
- Biologie du Médicament et Toxicologie, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Cochin, Paris, France
| | - Nihel Khoudour
- Biologie du Médicament et Toxicologie, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Cochin, Paris, France
| | - Laurent Chouchana
- Service de Pharmacologie, Centre Régional de Pharmacovigilance, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Cochin, Paris, France
| | - Lucie Chevillard
- Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, Paris, France
| | - Sophie Parat
- Service de Médecine et Réanimation néonatales, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Universitaire Cochin, Paris, France
| | - Xavier Declèves
- Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, Paris, France
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Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K, Yonkers K. WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019; 20:17-50. [PMID: 30632868 DOI: 10.1080/15622975.2018.1510185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.
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Affiliation(s)
- Florence Thibaut
- a University Hospital Cochin , Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Abdeslam Chagraoui
- b Neuronal and Neuroendocrine Differentiation and Communication Laboratory , Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Normandie Univ , UNIROUEN, INSERM, U1239, CHU Rouen , Rouen , France ; Department of Medical Biochemistry , Rouen University Hospital , Rouen , France
| | - Leslie Buckley
- c Addiction Services , University Health Network, University of Toronto , Toronto , Canada
| | - Florence Gressier
- d Department of Psychiatry , INSERM UMR1178 CESP, Univ. Paris-Sud , Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
| | - Javier Labad
- e Department of Mental Health , Parc Tauli Hospital Universitari, I3PT ; Department of Psychiatry and Legal Medicine , Universitat Autonoma de Barcelona, CIBERSAM, Sabadell , Barcelona , Spain
| | - Sandrine Lamy
- f Department of Addictology , Ramsay- General de Santé, SSR Petit Colmoulins , Harfleur , France
| | - Marc N Potenza
- g Neuroscience and Child Study , Yale University School of Medicine , New Haven , CT , USA
| | - Marta Rondon
- h Instituto Nacional Materno Perinatal , Lima , Peru
| | - Anita Riecher-Rössler
- i Center for Gender Research and Early Detection , University of Basel Psychiatric Hospital , Basel , Switzerland
| | - Michael Soyka
- j University of Munich , Munich, and Medicalpark Chiemseeblick, Bernau , Germany
| | - Kim Yonkers
- k Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences , Yale University , New Haven , CT , USA
| | - Kim Yonkers
- Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
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Managing Spasticity in a Pregnant Woman with Spinal Cord Injury: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0198-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Neonatal Adaptation Issues After Maternal Exposure to Prescription Drugs: Withdrawal Syndromes and Residual Pharmacological Effects. Drug Saf 2016; 39:903-24. [DOI: 10.1007/s40264-016-0435-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Freeman EH, Delaney RM. Neonatal Baclofen Withdrawal: A Case Report of an Infant Presenting With Severe Feeding Difficulties. J Pediatr Nurs 2016; 31:346-9. [PMID: 26810267 DOI: 10.1016/j.pedn.2015.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/28/2022]
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Alenazi NA, Manthorpe JM, Lai EP. Selective extraction of BPA in milk analysis by capillary electrophoresis using a chemically modified molecularly imprinted polymer. Food Control 2015. [DOI: 10.1016/j.foodcont.2014.10.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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