Rabu, 01 Juni 2011

Baclofen for medical professional


Baclofen (Systemic)


VA CLASSIFICATION
Primary: MS200
Secondary: CN103

Commonly used brand name(s): Apo-Baclofen; Lioresal; Novo-Baclofen; Nu-Baclofen; PMS-Baclofen.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Formssection(s).




Category:


Antispastic analgesic (in trigeminal neuralgia)—

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Spasticity (treatment)—Baclofen is indicated to relieve the signs and symptoms of spasticity caused by multiple sclerosis, spinal cord diseases, or spinal cord injury . It is especially useful in relieving flexor spasms and concomitant pain, clonus, and muscular rigidity . Baclofen may also improve bowel and bladder function in some patients with spinal lesions; however, it may not improve spastic stiff gait or manual dexterity.

[Neuralgia, trigeminal (treatment)]—Baclofen is used to reduce the number and severity of attacks of trigeminal neuralgia in patients who are not able to tolerate, or who have become refractory to the effects of, carbamazepine. In some patients, baclofen may provide additional benefit when used concurrently with carbamazepine.

Unaccepted
Baclofen should not be used in patients who require spasticity to sustain upright posture or balance in locomotion, or to obtain increased function .

Baclofen may not be effective, and is not recommended, in the treatment of patients with cerebrovascular accident, parkinsonism, cerebral palsy, or trauma-induced cerebral lesions .

Baclofen is not indicated in the treatment of skeletal muscle spasm caused by rheumatic disorders .

1 Not included in Canadian product labeling.


Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    213.66 

Mechanism of action/Effect:

The precise mechanism of action of baclofen has not been fully determined. It acts mainly at the spinal cord level to inhibit the transmission of both monosynaptic and polysynaptic reflexes, possibly by hyperpolarization of primary afferent fiber terminals resulting in antagonism of the release of putative excitatory transmitters (i.e., glutamic and aspartic acids). Actions at supraspinal sites may also be involved .


Other actions/effects:

Baclofen has general central nervous system (CNS)–depressant actions .

Absorption:

Rapid and extensive but subject to interpatient variation . Also, the rate and extent of absorption may decrease with increasing doses .

Protein binding:

Low (30%) .

Biotransformation:

Hepatic; only about 15% of a dose is metabolized .

Half-life:

2 to 4 hours .

Onset of action:

Highly variable; may range from hours to weeks.

Time to peak concentration:

Within 2 hours ..

Peak serum concentration

500 to 600 nanograms per mL (nanograms/mL) (2.34 to 2.81 micromoles/L) following a 40-mg single dose; concentration remains above 200 nanograms/mL (0.94 micromoles/L) for 8 hours.

Therapeutic serum concentration

80 to 400 nanograms/mL (0.37 to 1.87 micromoles/L).

Elimination:
    Renal; 70 to 85% of a dose is excreted unchanged within 24 hours. Small amounts may also be excreted via the feces. About 40% of a dose is usually excreted within 6 hours, and excretion is usually complete within 3 days; however, with chronic use the rate of excretion is subject to interpatient variation.


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Studies have not been done in humans .

Some studies in rats have shown that baclofen increases the incidence of omphaloceles (ventral hernias) and incomplete sternebral ossification in the fetus when given in doses approximately 13 times the maximum recommended human dose (MRHD) . However, these abnormalities did not occur in studies using mice or rabbits. Also, studies in rabbits have shown that baclofen causes an increased incidence of unossified phalangeal nuclei of forelimbs and hindlimbs in the fetus when given in doses approximately 7 times the MRHD . In addition, some studies in mice have shown that baclofen causes a reduction in fetal birth weight with consequent delays in skeletal ossification when given in doses 17 times or 34 times the MHRD .

Breast-feeding

Baclofen is distributed into breast milk . However, problems in humans have not been documented .

Pediatrics

No information is available on the relationship of age to the effects of baclofen in pediatric patients . Safety and efficacy in children up to 12 years of age have not been established .


Geriatrics


Geriatric patients may be especially at risk for the development of CNS toxicity, leading to hallucinations, confusion or mental depression, other psychiatric disturbances, or incapacitating sedation, during baclofen therapy. Also, elderly patients are more likely to have age-related renal function impairment, which may require a reduction of dosage in patients receiving baclofen.

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Antidepressants, tricyclic    (concurrent use with baclofen may result in pronounced muscle hypotonia; caution is recommended )


Antidiabetic agents, oral or
Insulin    (baclofen may increase blood glucose concentrations; dosage adjustments of these medications and/or of baclofen may be necessary during and after concurrent therapy )


Antihypertensives or
Other hypotension-producing medications    (concurrent use with baclofen may increase the risk of hypotension; dosage adjustment of the antihypertensive agent may be needed )


Carbidopa and levodopa    (concurrent use with baclofen may result in mental confusion, hallucinations, or agitation )


» CNS depression–producing medications, other (see ) or
» Monoamine oxidase (MAO) inhibitors, including furazolidone, procarbazine, and selegiline    (concurrent use may result in increased CNS-depressant and hypotensive effects; caution is recommended and dosage of one or both agents should be reduced )


Neuromuscular blocking agents    (concurrent use with neuromuscular blocking agents may enhance the effects of baclofen )



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With physiology/laboratory test values
Alanine aminotransferase (ALT [SGPT]) and
Alkaline phosphatase and
Aspartate aminotransferase (AST [SGOT])    (values may be increased)


Glucose, blood    (concentration may be increased)


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problems exist
Cerebral lesions or
Cerebrovascular accident    (increased risk of CNS, respiratory, or cardiovascular depression; ataxia; and psychiatric disturbances such as hallucinations, euphoria, and mental excitation, confusion, or depression)


Diabetes mellitus    (baclofen may increase blood glucose concentrations )


Epilepsy    (baclofen may cause deterioration of seizure control, electroencephalographic [EEG] changes)


Psychiatric disorders, pre-existing    (increased risk of baclofen-induced psychiatric disturbances)


» Renal function impairment    (baclofen may accumulate; reduction in dosage may be required)


Sensitivity to baclofen
Caution is required in geriatric patients, who may be especially susceptible to baclofen-induced CNS toxicity and who are more likely than younger adults to have renal function impairment.

Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Electroencephalogram (EEG) and clinical state determinations    (increased or periodic monitoring recommended for epileptic patients because baclofen may cause deterioration of seizure control and EEG changes in these patients)




Side/Adverse Effects

Note: Chronic administration of baclofen to female rats has caused a dose-related increase in the incidence of ovarian cysts and in enlarged and/or hemorrhagic adrenal glands .
Many of the CNS, visual, and genitourinary side effects listed below may be symptoms associated with the underlying spastic disease rather than baclofen-induced .

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence less frequent or rare
    
Bloody or dark urine
    
chest pain
    
CNS toxicity (visual and auditory hallucinations; mental depression or other mood changes; ringing or buzzing in ears)
    
dermatitis, allergic (skin rash or itching)
    
ovarian cysts —up to 5% of the female population using baclofen
    
syncope (fainting)



Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent
    
CNS effects (drowsiness [up to 63%]; dizziness or lightheadedness [up to 15%]; weakness [up to 15%]; confusion [up to 11%])
    
muscle weakness —may be caused by CNS effect or become apparent if baclofen-induced reduction of muscle tone unmasks existing paresis
    
nausea —4 to 12%

Incidence less frequent or rare
    
CNS effects (clumsiness, unsteadiness, trembling, or other problems with muscle control; false sense of well-being; headache [up to 8%]; muscle pain; numbness or tingling in hands or feet; slurred speech or other speech problems; trouble in sleeping [up to 7%]; unexplained muscle stiffness; unusual excitement; unusual tiredness [up to 4%])
    
constipation —2 to 6%
    
difficult or painful urination or decrease in amount of urine
    
fluid retention (swelling of ankles; weight gain)
    
frequent urge to urinate or uncontrolled urination —2 to 6%
    
gastrointestinal irritation (abdominal or stomach pain or discomfort; diarrhea)
    
loss of appetite
    
low blood pressure —up to 9%
    
pounding heartbeat
    
sexual problems in males
    
stuffy nose



Those indicating need for medical attention and/or reinstitution of therapy if they occur after medication is abruptly discontinued
    
Convulsions
    
hallucinations, visual and auditory
    
increased spasticity
    
mood or mental changes such as paranoid ideation or manic psychosis
    
unusual nervousness or restlessness




Overdose
For specific information on the agents used in the management of baclofen overdose, see in monograph.

For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see ).

Clinical effects of overdose 
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
Acute and chronic
    
CNS toxicity (blurred or double vision; convulsions; miosis; mydriasis; severe muscle weakness; strabismus)
    
respiratory depression (shortness of breath or unusually slow or troubled breathing)
    
vomiting


Treatment of overdose
To decrease absorption—May include emptying the stomach by induction of emesis and/or gastric lavage .

Specific treatment—Administration of atropine has been recommended to increase ventilation, heart rate, blood pressure, and core body temperature. See the package insert or in monograph.

Supportive care—May include maintaining adequate respiratory exchange. Respiratory stimulants should not be used. Patients in whom intentional overdose is confirmed or suspected should be referred for psychiatric consultation.


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Baclofen (Systemic) .

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to baclofen





Use in the elderly—Increased risk of adverse CNS effects
Other medications, especially other CNS depression–producing medications

Proper use of this medication

» Proper dosing
Missed dose: Taking if remembered within an hour or so; not taking if not remembered within an hour; not doubling doses

» Proper storage

Precautions while using this medication
» Checking with physician before discontinuing medication; gradual dosage reduction is necessary

» Avoiding alcohol or other CNS depressants

» Caution if drowsiness, dizziness, visual disturbances, or impaired coordination occur

Diabetics: May increase blood sugar concentrations


Side/adverse effects
Convulsions, hallucinations, mood or mental changes, increased spasticity, seizures, or unusual nervousness or restlessness may occur following abrupt withdrawal

Signs and symptoms of potential side effects, especially bloody or dark urine, chest pain, CNS toxicity, allergic dermatitis, and syncope


General Dosing Information
Side effects may be minimized by initiating therapy with low doses, which should be increased gradually until the desired response is obtained.

If the desired response is not achieved after a reasonable trial period, the medication should be slowly withdrawn .

Lower doses may be required in patients with renal function impairment .

Convulsions, hallucinations, other psychiatric disturbances, and exacerbation of spasticity have occurred following abrupt withdrawal of baclofen; gradual reduction of dosage over a period of 1 to 2 weeks or more is recommended before the medication is discontinued .


Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

BACLOFEN TABLETS USP

Usual adult and adolescent dose
Antispastic and
[Analgesic (in trigeminal neuralgia)]
Oral, 5 mg three times a day initially, then increased by increments of 5 mg per dose every three days until the desired response is achieved .


Note: A smoother response may be achieved in some patients if the total daily dose is given in four divided doses.


Usual adult prescribing limits
80 mg daily .

Note: Higher doses may be required in some patients.


Usual pediatric dose
Safety and efficacy have not been established.

Strength(s) usually available
U.S.—


10 mg (Rx) [Lioresal (scored)][Generic]


20 mg (Rx) [Lioresal (scored)][Generic]

Canada—


10 mg (Rx) [Apo-Baclofen] [Lioresal (scored)] [Novo-Baclofen] [Nu-Baclofen] [PMS-Baclofen]


20 mg (Rx) [Apo-Baclofen] [Lioresal (scored)] [Novo-Baclofen] [Nu-Baclofen] [PMS-Baclofen]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F) . Store in a well-closed container .

Auxiliary labeling:
   • May cause drowsiness .
   • Avoid alcoholic beverages .





Professional Information

Baclofen for patient

for Central Nervous System related spasticity, i found Baclofen is really very helpful to reduce your clumsy and stiffness. heres the drug information for customer/patients, taken from baclofen.com, please take alook


baclofen

Generic Name: baclofen (BAK loe fen)
Brand Names: Lioresal

What is baclofen?

Baclofen is a muscle relaxer and an antispastic agent.
Baclofen is used to treat muscle symptoms caused by multiple sclerosis, including spasm, pain, and stiffness.
Baclofen may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about baclofen?

Baclofen can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase some of the side effects of baclofen. Do not use baclofen at a time when muscle tone is needed to assure safe balance and movement for certain activities. In some situations, it may endanger your physical safety to be in a state of reduced muscle tone.
You may have withdrawal symptoms such as seizures or hallucinations, when you stop using baclofen after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

What should I discuss with my healthcare provider before taking baclofen?

Do not use this medication if you are allergic to baclofen.
Before taking baclofen, tell your doctor if you are allergic to any drugs, or if you have:
  • kidney disease;
  • epilepsy or other seizure disorder; or
  • a history of stroke or blood clots.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.
FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether baclofen passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
Older adults may be more sensitive to the effects of this medicine.
Do not give this medication to a child younger than 12 years old.

How should I take baclofen?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Your doctor may occasionally change your dose to make sure you get the best results from this medication.
You may take baclofen with or without food.
Call your doctor if your muscle symptoms do not improve after 2 weeks of taking this medication.
You may have withdrawal symptoms such as seizures or hallucinations, when you stop using baclofen after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.
Store baclofen at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include muscle weakness, vomiting, drowsiness, dilated or pinpoint pupils, weak or shallow breathing, fainting, or coma.

What should I avoid while taking baclofen?

Baclofen can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase some of the side effects of baclofen.
Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by baclofen.
Do not use baclofen at a time when muscle tone is needed to assure safe balance and movement for certain activities. In some situations, it may endanger your physical safety to be in a state of reduced muscle tone.

Baclofen side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
  • seizure (convulsions);
  • confusion, hallucinations; or
  • an uneven heartbeat.
Less serious side effects may include:
  • drowsiness, dizziness, weakness, tired feeling;
  • headache;
  • sleep problems (insomnia);
  • nausea, constipation; or
  • urinating more often than usual.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect baclofen?

There may be other drugs that can affect baclofen. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Advanced Consumer Information (Micromedex)

Senin, 01 November 2010

Chicken Pox (3): Bolehkah saya mandi?

Pertanyaan klasik para ibu saat anaknya terkena cacar air, juga pertanyaan yang sama yang ditanyakan oleh ibuku saat melihat anaknya yang terkena cacar air mau masak air hangat untuk mandi, "lho emang boleh mandi ya?"

Penderita cacar air dianjurkan untuk mandi untuk  menjaga higienisitas kulitnya. Supaya gelembung-gelembung tersebut tidak terinfeski oleh bakteri. ciri-ciri gelembung yang terinfeksi,yakni dasarnya mulai eritrem, cairan jernihnya berisi nanah. Bekas pecahan gelembung tersebut pun harus kita rawat dengan mengoleskan salep antibakteri supaya tidak terifeksi. Karena infeksi sekunder oleh bakteri akan meninggalkan jejak parut yang berbekas.

Taburkan bedak juga untuk melicinkan kulit agar gelembung-gelembung yang masih utuh tidak pecah.

Sup Chicken Pox (2): haruskah saya minum antivirus?

Pada anak-anak biasanya prognosisnya baik, sehingga tidak diperlukan antivirus. Justru pada dewasalah penyakit ini manisfestasinya lebih banyak menimbulkan penyulit, bisa berupa pneumonia dan ensefalitis. (Pada diriku manifestasi nyerinya lebih nyata. Terasa pegal da nyeri terutama pada tempat vesikel pecah.) Sehingga untuk pasien diatas 12 tahun dan yang memiliki gangguan imunitas (imunocompromised) dianjurkan diberikan antivirus seperti acyclovir atau valacyclovir per oral.

Selebih daripada itu penatalakasanaan varicella sebenarnya hanyalah simptomatik, khas penyakit virus. Dengan mengkonsumsi obat-obatan yang meringankan gejala. Jika panas dianjurkan untuk diberikan obat panas seperti parasetamol. Hindari penggunaan aspirin pada anak-anak karena bisa menyebabkan sindroma reye. Untuk batuk pilek diberikan obat sesuai gejalanya.

untuk mengatasi gatal dianjurkan menggunakan antihistamin per oral, jangan calamin lotion. Namun pada praktek sehari-hari biasanya saya menganjurkan menggunakan bedak salisil, yang akan meringankan gatal, sekaligus membantu melicinkan kulit sehingga vesikel tersebut tidak mudah pecah.
Pemberian salep antivirus berdasarkan teoritis tidak memberikan hasil yang memuaskan.Sehingga pasien kita bekali dengan salep antibiotik saja, yang dioleskan pada bekas gelembung yang pecah atau gelembung yang cairannya sudah berubah menjadi nanah.

Chicken Pox: Petok petok tok tok tok

Setelah sekian lama menghindar, akhirnya aku kena juga cacar air.  Dahulu saat koas, sudah terdengar selentingan barang siapa belum kena cacar, biasanya seudah stase anak pasti kena... namun syukurlah diriku tidak. Sekarang sebagai dokter tentu saja aku bertemu dengan pasien cacar air, berhubung khas dan tipikal penyakit kulit yang bisa diterawang dari jauh... aku pun segera menulis resep, sambil menahan nafas, segera mempersilakan pasien anak tersebut untuk segera beranjak.

Ya demikianlah diriku, sekarang sudah terkena cacar air. Terpaksa dan dipaksa untuk istirahat, bukan karena berat tapi aku menyadari diriku infeksius, terutama bagi pasien pediatrik. Tinggal merencanakan liburn 10 hari ini supaya bermanfaat, bukan hanya hardolin saja,hahahah.