Olgu Sunumu
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Baklofen Yoksunluğu Sergileyen Bir Olgu: Klinik Görüşler ve İlaca Ulaşımın Düzenlenme İhtiyacı

Yıl 2025, Cilt: 26 Sayı: 3, 376 - 380, 30.09.2025
https://doi.org/10.51982/bagimli.1654283

Öz

Madde kullanım bozuklukları (MKB) bireylerin sağlığını ve toplumu önemli ölçüde etkilemekte, baklofen de dahil olmak üzere reçeteli ilaçların kötüye kullanımı yeni bir endişe kaynağı haline gelmektedir. Spastisite ve etiket dışı alkol kullanım bozukluğu (AUD) için kullanılan bir GABA-B reseptör agonisti olan baklofen, aniden kesildiğinde toksisite ve şiddetli yoksunluk riskleri taşır. Bu makalede, baklofeni 1000 mg/gün'e çıkaran, deliryum ve rabdomiyoliz dahil olmak üzere bağımlılık ve yoksunluk semptomlarına yol açan, çoklu madde kullanımı olan 31 yaşında bir erkek olgu sunulmuştur. Tedavi için baklofenin yeniden verilmesi, benzodiazepinler, antipsikotikler ve destekleyici bakım gerekmiştir. Bu vaka, özellikle SUD'li bireylerde baklofen'in kötüye kullanım potansiyelini vurgulamakta ve özellikle reçetesiz olarak kolayca erişilebildiği bölgelerde dikkatli reçeteleme ve düzenleyici kontrol ihtiyacının altını çizmektedir.

Kaynakça

  • Citaristi I. The Europa Directory of International Organizations 2022. Helen C (editor). United Nations Office on Drugs and Crime—UNODC. London: Routledge, 2022: 248-252.
  • Ünübol H, Hızlı Sayar G. Prevalence and sociodemographic determinants of substance use in Turkey. Eur Addict Res 2021; 27(6): 447-456.
  • Evren C. Alkol ve Madde Kullanım Bozuklukları Temel Başvuru Kitabı, 2. Baskı. Ankara: Türkiye Psikiyatri Derneği Yayınları, 2023.
  • Kent CN, Park C, Lindsley CW. Classics in chemical neuroscience: Baclofen. ACS Chem Neurosci 2020; 11(12): 1740-1755.
  • Romito JW, Turner ER, Rosener JA, et al. Baclofen therapeutics, toxicity, and withdrawal: A narrative review. SAGE Open Med 2021; 9: 20503121211022197.
  • Leung NY, Whyte IM, Isbister GK. Baclofen overdose: defining the spectrum of toxicity. Emerg Med Australas 2006; 18(1): 77-82.
  • Watve SV, Sivan M, Raza WA, Jamil FF. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord 2012; 50(2): 107-111.
  • Alvis BD, Sobey CM. Oral baclofen withdrawal resulting in progressive weakness and sedation requiring intensive care admission. Neurohospitalist 2017; 7(1): 39-40.
  • Ross JC, Cook AM, Stewart GL, Fahy BG. Acute intrathecal baclofen withdrawal: A brief review of treatment options. Neurocrit Care 2011; 14(1): 103-108.
  • Paulson GW. Overdose of lioresal. Neurology 1976; 26(11): 1105-1106.
  • Chan WL, Dargan PI, Haynes CM, et al. Misuse of prescription medicines is as prevalent as the use of recreational drugs and novel psychoactive substances in Singapore: An unrecognised public health issue? Singapore Med J 2022; 63(10): 572-576.
  • Dionisi T, Di Sario G, De Mori L, et al. Current treatments of alcohol use disorder. Int Rev Neurobiol 2024; 175: 127-152.
  • Pierce M, Sutterland A, Beraha EM, et al. Efficacy, tolerability, and safety of low-dose and high-dose baclofen in the treatment of alcohol dependence: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2018; 28(7): 795-806.
  • Agabio R, Saulle R, Rösner S, Minozzi S. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023; 1(1): CD012557.
  • de Beaurepaire R, Jaury P. Baclofen in the treatment of alcohol use disorder: tailored doses matter. Alcohol Alcohol 2024; 59(2): agad090.
  • Singier A, Noize P, Berdaï D, et al. Medicine misuse: A systematic review and proposed hierarchical terminology. Br J Clin Pharmacol 2021; 87(4): 1695-1704.
  • Kroin JS, Bianchi GD, Penn RD. Intrathecal baclofen down-regulates GABAB receptors in the rat substantia gelatinosa. J Neurosurg 1993; 79(4): 544-549.
  • Coffey RJ, Edgar TS, Francisco GE, et al. Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 2002; 83(6): 735-741.
  • Bose P, Parmer R, Thompson FJ. Velocity-dependent ankle torque in rats after contusion injury of the midthoracic spinal cord: time course. J Neurotrauma 2002; 19(10): 1231-1249.
  • Meythaler JM, Roper JF, Brunner RC. Cyproheptadine for intrathecal baclofen withdrawal. Arch Phys Med Rehabil 2003; 84(5): 638-642.
  • Pelerin JM, Fristot L, Gibaja V, et al. Non-medical use of baclofen: A case series and review of the literature. Therapie 2023; 78(6): 615-637.

A Case with Baclofen Withdrawal: Clinical Insights and the Need for Regulated Access

Yıl 2025, Cilt: 26 Sayı: 3, 376 - 380, 30.09.2025
https://doi.org/10.51982/bagimli.1654283

Öz

Substance use disorders (SUDs) significantly impact individuals' health and society, with prescription drug misuse, including baclofen, becoming an emerging concern. Baclofen, a GABA-B receptor agonist used for spasticity and off-label alcohol use disorder (AUD), carries risks of toxicity and severe withdrawal upon abrupt discontinuation. We present a case of a 31-year-old male with polysubstance abuse who escalated baclofen to 1000 mg/day, leading to dependence and withdrawal symptoms, including delirium and rhabdomyolysis. Treatment required baclofen reintroduction, benzodiazepines, antipsychotics, and supportive care. This case highlights baclofen’s misuse potential, particularly in individuals with SUDs, and underscores the need for cautious prescribing and regulatory control, especially in regions where it is easily accessible without a prescription.

Etik Beyan

The patient provided written informed consent for the publication of the case report.

Kaynakça

  • Citaristi I. The Europa Directory of International Organizations 2022. Helen C (editor). United Nations Office on Drugs and Crime—UNODC. London: Routledge, 2022: 248-252.
  • Ünübol H, Hızlı Sayar G. Prevalence and sociodemographic determinants of substance use in Turkey. Eur Addict Res 2021; 27(6): 447-456.
  • Evren C. Alkol ve Madde Kullanım Bozuklukları Temel Başvuru Kitabı, 2. Baskı. Ankara: Türkiye Psikiyatri Derneği Yayınları, 2023.
  • Kent CN, Park C, Lindsley CW. Classics in chemical neuroscience: Baclofen. ACS Chem Neurosci 2020; 11(12): 1740-1755.
  • Romito JW, Turner ER, Rosener JA, et al. Baclofen therapeutics, toxicity, and withdrawal: A narrative review. SAGE Open Med 2021; 9: 20503121211022197.
  • Leung NY, Whyte IM, Isbister GK. Baclofen overdose: defining the spectrum of toxicity. Emerg Med Australas 2006; 18(1): 77-82.
  • Watve SV, Sivan M, Raza WA, Jamil FF. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord 2012; 50(2): 107-111.
  • Alvis BD, Sobey CM. Oral baclofen withdrawal resulting in progressive weakness and sedation requiring intensive care admission. Neurohospitalist 2017; 7(1): 39-40.
  • Ross JC, Cook AM, Stewart GL, Fahy BG. Acute intrathecal baclofen withdrawal: A brief review of treatment options. Neurocrit Care 2011; 14(1): 103-108.
  • Paulson GW. Overdose of lioresal. Neurology 1976; 26(11): 1105-1106.
  • Chan WL, Dargan PI, Haynes CM, et al. Misuse of prescription medicines is as prevalent as the use of recreational drugs and novel psychoactive substances in Singapore: An unrecognised public health issue? Singapore Med J 2022; 63(10): 572-576.
  • Dionisi T, Di Sario G, De Mori L, et al. Current treatments of alcohol use disorder. Int Rev Neurobiol 2024; 175: 127-152.
  • Pierce M, Sutterland A, Beraha EM, et al. Efficacy, tolerability, and safety of low-dose and high-dose baclofen in the treatment of alcohol dependence: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2018; 28(7): 795-806.
  • Agabio R, Saulle R, Rösner S, Minozzi S. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023; 1(1): CD012557.
  • de Beaurepaire R, Jaury P. Baclofen in the treatment of alcohol use disorder: tailored doses matter. Alcohol Alcohol 2024; 59(2): agad090.
  • Singier A, Noize P, Berdaï D, et al. Medicine misuse: A systematic review and proposed hierarchical terminology. Br J Clin Pharmacol 2021; 87(4): 1695-1704.
  • Kroin JS, Bianchi GD, Penn RD. Intrathecal baclofen down-regulates GABAB receptors in the rat substantia gelatinosa. J Neurosurg 1993; 79(4): 544-549.
  • Coffey RJ, Edgar TS, Francisco GE, et al. Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 2002; 83(6): 735-741.
  • Bose P, Parmer R, Thompson FJ. Velocity-dependent ankle torque in rats after contusion injury of the midthoracic spinal cord: time course. J Neurotrauma 2002; 19(10): 1231-1249.
  • Meythaler JM, Roper JF, Brunner RC. Cyproheptadine for intrathecal baclofen withdrawal. Arch Phys Med Rehabil 2003; 84(5): 638-642.
  • Pelerin JM, Fristot L, Gibaja V, et al. Non-medical use of baclofen: A case series and review of the literature. Therapie 2023; 78(6): 615-637.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Madde Bağımlılığı
Bölüm Olgu Sunumu
Yazarlar

Salim Çağatay Kağızman 0000-0002-1448-6502

Ahmet Alp Karakaşlı 0000-0002-1472-1437

Gönderilme Tarihi 10 Mart 2025
Kabul Tarihi 8 Mayıs 2025
Yayımlanma Tarihi 30 Eylül 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 26 Sayı: 3

Kaynak Göster

AMA Kağızman SÇ, Karakaşlı AA. A Case with Baclofen Withdrawal: Clinical Insights and the Need for Regulated Access. Bağımlılık Dergisi. Eylül 2025;26(3):376-380. doi:10.51982/bagimli.1654283