Dose de baclofène (baclofène), indications, effets indésirables, interactions … from PDR.net | Lutte Bégaiement

DES CLASSES

Agents en vrac pour la composition
Kits de composition divers
Relaxants musculaires à action centrale, unis

AVERTISSEMENT EN BOÎTE

Arrêt brutal

Éviter l’arrêt brusque du traitement intrathécal au baclofène. L'arrêt brutal du baclofène intrathécal, quelle que soit sa cause, a provoqué des réactions sévères telles qu'une forte fièvre, une altération de l'état mental, une spasticité exagérée du rebond et une rigidité musculaire qui, dans de rares cas, ont évolué vers la rhabdomyolyse, une défaillance de plusieurs organes du système et la mort. Le priapisme peut également se développer ou se reproduire si le traitement intrathécal est interrompu. La prévention de l’arrêt brutal du baclofène intrathécal nécessite une attention particulière à la programmation et à la surveillance du système de perfusion, au calendrier et aux procédures de remplissage, ainsi qu’aux alarmes de pompe. Les patients et les soignants doivent être informés de l'importance de respecter les visites de renouvellement prévues et doivent être informés des premiers symptômes du sevrage au baclofène. Une attention particulière doit être accordée aux patients à risque (par exemple, lésions de la moelle épinière à T6 ou plus, difficultés de communication, ou antécédents de symptômes de sevrage dus au baclofène oral ou intrathécal). Un diagnostic et un traitement rapides et précis sont importants pour prévenir les effets systémiques du sevrage intrathécal de baclofène sur le système nerveux central, pouvant mettre la vie en danger. Le cas échéant, le baclofène oral et / ou les benzodiazépines orales ou intraveineuses peuvent être envisagés en cas d’urgence.[42609] [42610] Évitez également l’arrêt soudain du baclofène par voie orale après une utilisation chronique; L'arrêt brutal est associé à de la confusion, des hallucinations, d'autres troubles psychiatriques, des convulsions et des exacerbations de la spasticité. Une réduction progressive de la posologie sur une période de 2 semaines ou plus est recommandée.

LA DESCRIPTION

Myorelaxant oral; dérivé du neurotransmetteur inhibiteur GABA; utilisé pour traiter la spasticité chez les patients atteints de SEP et d'autres lésions de la moelle épinière; améliore également la fonction intestinale et la vessie chez certains de ces patients.

NOMS DE MARQUE COMMUNS

BACLOFEN, ED Baclofène, EnovaRX, Baclofène d’Equipto, Premier baclofène, Gablofen, Lioresal

COMMENT FOURNIE

Baclofène / BACLOFEN / EnovaRX / Equipto Topique Pwd F / Recon: 0.6g, 1.2g, 2%
Baclofen / ED Baclofen / Lioresal Oral Tab: 5 mg, 10 mg, 20 mg
Baclofène / Intrathecal Lioresal Inj Sol: 0,05 mg, 0,5 mg, 1 ml, 2 mg, 1000 mg
Premier baclofène oral Fw / Recon: 1 mg, 5 mg
Gablofen Intrathecal Sol: 1 ml, 50 mg, 500 mg, 1000 mg, 2000 mg

POSOLOGIE ET ​​INDICATIONS

Pour le traitement de la spasticité, des spasmes musculaires (non dus à des affections rhumatismales), de la myoclonie et de la rigidité musculaire en cas de sclérose en plaques et de lésions ou maladies de la moelle épinière.
REMARQUE: L'efficacité du baclofène par voie orale n'a pas été établie dans les cas d'accident vasculaire cérébral, de paralysie cérébrale et de maladie de Parkinson. Son utilisation n'est donc pas recommandée par le fabricant.

Pour la spasticité grave due à la sclérose en plaques, la paralysie cérébrale, une lésion de la colonne vertébrale ou une lésion cérébrale traumatique; ou chez les patients qui ne répondent pas au traitement par baclofène par voie orale ou chez ceux qui présentent des effets indésirables intolérables à des doses orales efficaces.
REMARQUE: Le baclofène intrathécal a été désigné comme médicament orphelin par la FDA pour cette indication.

Dose intrathécale (dose de dépistage)

Adultes

La posologie nécessite des procédures spéciales, un dépistage du patient et des techniques de dosage; consulter des ressources spécialisées. La dose de dépistage initiale recommandée est de 50 µg par voie intrathécale par barbotage sur une période d'au moins 1 minute. Le patient est observé pendant 4 à 8 heures. Une réponse positive consiste en une diminution significative du tonus musculaire et / ou de la fréquence et / ou de la sévérité des spasmes. Si la réponse initiale est inférieure à celle souhaitée, un second bolus de 75 µg par voie intrathécale peut être administré 24 heures après la première dose et observé pendant 4 à 8 heures. Si la réponse est toujours insuffisante, un bolus final de 100 µg par voie intrathécale peut être administré 24 heures plus tard. Les patients qui ne répondent pas à la dose de 100 µg ne doivent pas être considérés comme candidats à une pompe implantée pour perfusion chronique.

Enfants de 4 ans et plus

La posologie nécessite des procédures spéciales, un dépistage du patient et des techniques de dosage; consulter des ressources spécialisées. La dose et la procédure de dépistage initiales sont les mêmes que chez l’adulte, soit initialement 50 µg par voie intrathécale. Cependant, pour les très petits patients, une dose de dépistage intrathécal de 25 µg peut être essayée en premier.

Dosage intrathécal (titration de la dose)

Adultes

Le dosage nécessite des techniques de dosage spéciales et une surveillance; consulter des ressources spécialisées. La dose de dépistage qui a donné une réponse positive doit être doublée et administrée sous forme de perfusion intrathécale continue sur une période de 24 heures, à moins que l'efficacité de la dose de bolus de dépistage n'ait été maintenue pendant au moins 8 heures. Dans ce cas, la dose quotidienne initiale devrait être la dose de dépistage administrée par voie intrathécale sur une période de 24 heures. Aucune augmentation de la dose ne doit être administrée dans les 24 premières heures. Après les 24 premières heures, la posologie quotidienne doit être augmentée lentement par incréments de 10% à 30% pour la spasticité de la moelle épinière ou de 5% à 15% pour la spasticité d’origine cérébrale par période de 24 heures, jusqu’à obtention de l’effet clinique souhaité. atteint.

Enfants de 4 ans et plus

Le dosage nécessite des techniques de dosage spéciales et une surveillance; consulter des ressources spécialisées. La dose de dépistage qui a donné une réponse positive doit être doublée et administrée sous forme de perfusion intrathécale continue sur une période de 24 heures, à moins que l'efficacité de la dose de bolus de dépistage n'ait été maintenue pendant au moins 8 heures. Dans ce cas, la dose quotidienne initiale devrait être la dose de dépistage administrée par voie intrathécale sur une période de 24 heures. Aucune augmentation de la dose ne doit être administrée dans les 24 premières heures. Après les 24 premières heures, la posologie quotidienne doit être augmentée lentement, par incréments de 5% à 15% par période de 24 heures, jusqu'à obtention de l'effet clinique souhaité.

Dose d'entretien intrathécale (spasticité d'origine rachidienne)

Adultes

La posologie d'entretien pour la perfusion intrathécale continue à long terme a varié de 12 µg / jour à 2 003 µg / jour, la plupart des patients étant maintenus à des doses de 300 à 800 µg / jour. L'expérience avec des doses supérieures à 1 000 mcg / jour est limitée. Les doses sont ajustées en fonction de la réponse avec la dose efficace la plus faible possible. Lors des remplissages périodiques de la pompe, la dose quotidienne peut être augmentée de 10% à 40%, sans dépasser 40%, afin de maintenir un contrôle adéquat des symptômes. La dose quotidienne peut être diminuée de 10% à 20% si les patients présentent des effets indésirables. Une augmentation soudaine et importante de la dose suggère une complication du cathéter (c'est-à-dire un pli ou un déplacement du cathéter).

Enfants de 4 ans et plus

Pour les enfants de moins de 12 ans, la dose moyenne était de 274 mcg / jour par voie intrathécale (24 à 1 199 mcg / jour). Les exigences posologiques pour les enfants de plus de 12 ans ne sont pas significativement différentes de celles des adultes. Lors des remplissages périodiques de la pompe, la dose quotidienne peut être augmentée de 5% à 20%, mais pas plus de 20%, afin de maintenir un contrôle adéquat des symptômes. La dose quotidienne peut être diminuée de 10% à 20% si les patients présentent des effets indésirables. Une augmentation soudaine et importante de la dose suggère une complication du cathéter (c'est-à-dire un pli ou un déplacement du cathéter).

Dose d'entretien intrathécale (spasticité d'origine cérébrale)

Adultes

La posologie d'entretien pour la perfusion intrathécale continue à long terme a varié de 22 à 1400 mcg / jour, la plupart des patients ayant maintenu une posologie allant de 90 à 703 mcg / jour. L'expérience avec des doses supérieures à 1 000 mcg / jour est limitée. Lors des remplissages périodiques de la pompe, la dose quotidienne peut être augmentée de 5% à 20%, mais pas plus de 20%, afin de maintenir un contrôle adéquat des symptômes. La dose quotidienne peut être diminuée de 10% à 20% si les patients présentent des effets indésirables. Une augmentation soudaine et importante de la dose suggère une complication du cathéter (c'est-à-dire un pli ou un déplacement du cathéter).

Enfants de 4 ans et plus

Pour les enfants de moins de 12 ans, la dose moyenne était de 274 mcg / jour par voie intrathécale (24 à 1 199 mcg / jour). Les exigences posologiques pour les enfants de plus de 12 ans ne sont pas significativement différentes de celles des adultes. Lors des remplissages périodiques de la pompe, la dose quotidienne peut être augmentée de 5% à 20%, mais pas plus de 20%, afin de maintenir un contrôle adéquat des symptômes. La dose quotidienne peut être diminuée de 10% à 20% si les patients présentent des effets indésirables. Une augmentation soudaine et importante de la dose suggère une complication du cathéter (c'est-à-dire un pli ou un déplacement du cathéter).

Dosage oral

Adultes et Adolescents

Un dosage optimal nécessite un titrage minutieux. Initialement, 5 mg de PO 3 fois par jour, augmentez lentement tous les 3 jours de 5 mg de PO 3 fois / jour jusqu'à 40 à 80 mg / jour, en 3 à 4 doses fractionnées. Les réactions indésirables peuvent être minimisées en augmentant lentement la posologie. Un schéma thérapeutique 4 fois par jour peut fournir un meilleur contrôle chez certains patients. La dose maximale recommandée par le fabricant est de 80 mg / jour. Toutefois, certains cliniciens suggèrent que des doses allant jusqu'à 150 mg / jour sont bien tolérées et offrent un avantage thérapeutique. Certains patients nécessitent un traitement de 1 à 2 mois pour un bénéfice complet. Évitez l’arrêt brusque du traitement.

Enfants de 8 à 12 ans †

Initialement, 10 à 15 mg / jour de PO en 3 doses fractionnées. Titrer lentement tous les 3 jours, par paliers de 5 à 15 mg, jusqu'à une dose maximale de 60 mg / jour.

Enfants de 2 à 7 ans †

Initialement, 10 à 15 mg / jour de PO en 3 doses fractionnées. Titrer lentement tous les 3 jours, par paliers de 5 à 15 mg, jusqu'à une dose maximale de 40 mg / jour.

Pour le traitement du singultus persistant (hoquet) †.

Dosage oral

Adultes

Le baclofène peut être aussi efficace que d'autres agents déjà utilisés. Une dose de 10 mg de PO 4 fois par jour a été utilisée.

Pour le traitement de la névralgie du trijumeau †.

Dosage oral

Adultes

Des doses initiales de 10 mg de PO 3 fois par jour avec une titration de 10 mg tous les deux jours ont été utilisées. La dose maximale est de 80 mg / jour en doses fractionnées. Une diminution significative du nombre d'attaques liées à la névralgie du trijumeau a été rapportée chez 7 patients sur 10 dans une étude croisée contrôlée par placebo et chez 37 patients sur 50 dans un essai ouvert au baclofène.

Pour le traitement du nystagmus vestibulaire central †.

Dosage oral

Adultes

Au départ, 5 mg de PO 3 fois par jour. Augmenter la dose de 5 mg par semaine pour ne pas dépasser 80 mg / jour. Il est conseillé d’individualiser la posologie en fonction de la réponse clinique et de la tolérance.

Pour prévenir le priapisme bégaiement † (c'est-à-dire le priapisme récurrent).

Dosage oral

Adultes

Deux rapports de cas suggèrent que 40 mg de PO au coucher est efficace. La résolution complète du priapisme s'est produite chez 2 patients atteints de priapisme idiopathique. Chez les deux patients, le baclofène a été initié à 10 mg de PO au coucher et titré pour produire l'effet souhaité; Le priapisme a été éliminé à une dose de 40 mg / jour. Le priapisme n'a pas récidivé avec une administration chronique (plus de 5 mois chez un patient et plus de 12 mois chez l'autre); la fonction sexuelle est restée intacte.

Pour le traitement d'appoint du reflux gastro-oesophagien (RGO) symptomatique † chez les patients réfractaires.

Dosage oral

Adultes

5 à 20 mg de PO 3 fois par jour peuvent être envisagés chez les patients présentant une documentation objective du maintien du RGO symptomatique malgré le traitement optimal avec un IPP. Des données limitées issues d'études à court terme non contrôlées suggèrent des avantages tels qu'une réduction de la relaxation transitoire du SOI, des épisodes de reflux, des événements de reflux acide et non acide post-prandiaux, une activité de reflux nocturne et des épisodes d'éructations. Les données d'efficacité et de sécurité à long terme ne sont pas disponibles.

† Indique une utilisation non indiquée sur l'étiquette

DOSAGE MAXIMUM

Adultes

Une posologie de 80 mg / jour a été recommandée, mais des doses allant jusqu'à 150 mg / jour ont été administrées sans danger chez certains patients. La posologie maximale n’est pas disponible pour le baclofène intrathécal.

Les personnes âgées

Une posologie de 80 mg / jour a été recommandée, mais des doses allant jusqu'à 150 mg / jour ont été administrées sans danger chez certains patients. La posologie maximale n’est pas disponible pour le baclofène intrathécal.

Les adolescents

Une posologie de 80 mg / jour a été recommandée, mais des doses allant jusqu'à 150 mg / jour ont été administrées sans danger chez certains patients. La posologie maximale n’est pas disponible pour le baclofène intrathécal.

Les enfants

> = 8 ans: 60 mg / jour de PO a été recommandé. La posologie maximale n’est pas disponible pour le baclofène intrathécal.
2-7 ans: une dose de 40 mg / jour a été recommandée. La posologie maximale n’est pas disponible pour le baclofène intrathécal. L'utilisation sûre et efficace du baclofène intrathécal n'a pas été établie chez les enfants de moins de 4 ans.
<2 ans: Non recommandé.

CONSIDÉRATIONS DE DOSAGE

Affaiblissement hépatique

Aucun ajustement posologique nécessaire.

Insuffisance rénale

CrCl supérieur à 80 mL / minute: Aucun ajustement de la posologie n'est nécessaire.
CrCl 50 à 80 mL / minute: Réduisez la posologie de PO du tiers.
CrCl 30 à 50 mL / minute: Réduisez la dose de PO de moitié.
CrCl inférieur à 30 ml / minute et non sous dialyse: Réduisez la posologie de PO des deux tiers.

Utilisez le baclofène intrathécal avec prudence chez les patients présentant une insuffisance rénale. Une réduction de la posologie peut être nécessaire. Les directives spécifiques pour les ajustements de dosage dans l'insuffisance rénale ne sont pas disponibles.

Hémodialyse intermittente
Les thérapies alternatives doivent être envisagées en raison du potentiel d'effets indésirables graves. Les propriétés pharmacocinétiques du baclofène (c'est-à-dire une faible liaison aux protéines et un volume de distribution) et un faible poids moléculaire (213 daltons) suggèrent que l'hémodialyse devrait être utile pour éliminer le baclofène du sang en cas de toxicité clinique; bien que l'efficacité de l'hémodialyse à cette fin n'ait pas été établie.

ADMINISTRATION

Administration par voie orale

Formulations solides orales

Les comprimés de baclofène peuvent être administrés avec de la nourriture ou du lait pour minimiser les irritations gastriques.
Chaque fois que le baclofène est arrêté, la posologie quotidienne doit être progressivement réduite; L'arrêt brusque peut entraîner des effets indésirables.
Comprimés à désintégration orale (Kemstro): Avec les mains sèches, placez sur la langue du patient et laissez-le se dissoudre, puis faites-le avaler au patient. Peut être pris avec ou sans eau.

Administration injectable

Pour administration intrathécale uniquement par injection ou perfusion continue; ne pas administrer par voie parentérale ou par voie épidurale.
Inspecter visuellement les produits parentéraux pour détecter les particules et la décoloration avant l’administration chaque fois que la solution et le récipient le permettent.

Administration intrathécale

N'utilisez que des pompes implantables approuvées par la FDA pour l'administration de perfusions intrathécales continues de baclofène. Reportez-vous au manuel de la pompe implantable pour connaître les instructions spécifiques et les précautions relatives à la programmation de la pompe et au remplissage du réservoir.
Avant l'implantation à la pompe et l'initiation d'un traitement intrathécal chronique au baclofène, les patients doivent démontrer une réponse positive à une dose intrathécale de baclofène dans le cadre d'un essai de dépistage.
Évitez d’utiliser des seringues préremplies de baclofène pour injection intrathécale (Gablofen) dans un environnement aseptique (salle d’opération, par exemple) pour remplir les pompes intrathécales stériles avant implantation chez les patients, en raison de la surface externe non stérile de la seringue et du risque de contamination. L'injection de baclofène dans des flacons peut être utilisée avec une technique aseptique conventionnelle pour remplir les pompes intrathécales avant l'implantation.
Si des seringues préremplies sont utilisées pour remplir les pompes intrathécales avant l'implantation, la surface externe de la seringue doit être traitée pour garantir sa stérilité.
Des procédures doivent également être en place pour éviter la contamination des surfaces stériles par le contact avec la surface externe non stérile des seringues préremplies lors du remplissage de pompes intrathécales implantables en consultation externe.[42610] [42609]

Dilution:
La dilution de l'injection de baclofène n'est pas nécessaire avant l'utilisation. Cependant, si une concentration de baclofène non disponible dans le commerce est nécessaire, diluez-la uniquement avec du chlorure de sodium injectable stérile sans agent de conservation.
La concentration spécifique à utiliser dépend de la dose quotidienne totale requise ainsi que du débit de la pompe. L’injection intrathécale de baclofène peut nécessiter une dilution lorsqu’elle est utilisée dans certaines pompes. Consultez le manuel du fabricant pour des recommandations spécifiques.[42609] [42610]

Administration intrathécale:
Administrer la dose de test de dépistage par voie intrathécale pendant au moins 1 minute en utilisant du barbotage. Après détermination de la réponse du patient, le baclofène peut être administré par perfusion intrathécale continue à l'aide d'une pompe à perfusion contrôlée implantable.
Si les patients ont besoin de plusieurs vitesses de perfusion pour un contrôle optimal des symptômes, les changements de débit doivent être programmés pour commencer 2 heures avant le moment de l'effet clinique souhaité.
ALERTE: Évitez l’arrêt brutal du traitement intrathécal au baclofène, qui pourrait être grave et entraîner des séquelles potentiellement fatales. La prévention de l’arrêt brutal du baclofène intrathécal nécessite une attention particulière à la programmation et à la surveillance du système de perfusion, au calendrier et aux procédures de remplissage, ainsi qu’aux alarmes de pompe.
ALERTE: Une perfusion excessive d'un volume de médicament supérieur au débit programmé peut entraîner un surdosage ou un sevrage imprévu, provoqués par une vidange précoce du réservoir. Si une sur-perfusion est suspectée, reportez-vous aux instructions du fabricant pour remplir le réservoir et contactez le fabricant de la pompe. La réduction de la dose et de la concentration n'est pas recommandée comme solution pour la perfusion excessive. Plusieurs facteurs peuvent augmenter le risque de sur-perfusion, notamment l'utilisation de préparations médicamenteuses non indiquées, le remplissage excessif du réservoir de la pompe, le fonctionnement de la pompe sans fluide dans le réservoir, l'obstruction du cathéter et les arrêts de la pompe ou le moteur pendant 48 heures ou plus. .[42609] [42610]

ESPACE DE RANGEMENT

Générique:
– Stocker à une température ambiante contrôlée (entre 68 et 77 degrés F)
BACLOFEN:
– Information de stockage non disponible
ED baclofène:
– Stocker à une température ambiante contrôlée (entre 68 et 77 degrés F)
EnovaRX:
– magasin à 77 degrés F; excursions autorisées à 59-86 degrés F
– À conserver dans un endroit frais et sec
Equipto Baclofen:
– Jeter le produit reconstitué non utilisé après 30 jours
– Avant la composition, conserver à la température ambiante (entre 59 et 86 degrés F)
– Protéger de la lumière
– Le produit reconstitué peut être conservé à une température ambiante contrôlée (68 à 77 degrés F)
Premier baclofène:
– Jeter le produit reconstitué non utilisé après 30 jours
– Protéger du gel
– Protéger de la lumière
– Stockez à la température ambiante (entre 59 et 86 degrés F)
Gablofen:
– Jeter le produit s'il contient des particules, s'il est trouble ou s'il est décoloré
– Jeter la portion inutilisée. Ne pas stocker pour une utilisation ultérieure.
– Ne pas autoclaver
– Ne pas congeler
– La réfrigération n'est pas nécessaire
– Magasin entre 68 à 77 degrés F, excursions permises 59 à 86 degrés F
Lioresal:
– Stocker à une température ambiante contrôlée (entre 68 et 77 degrés F)

CONTRE-INDICATIONS / PRÉCAUTIONS

Informations générales

La surface externe des seringues préremplies de baclofène pour injection intrathécale (gablofène) est non stérile et son utilisation dans des conditions aseptiques (par exemple, une salle d’opération) est déconseillée en raison du risque de contamination et du risque de contamination. effets indésirables consécutifs. Si des seringues préremplies sont utilisées pour remplir les pompes intrathécales avant l’implantation, la surface externe de la seringue doit être traitée pour assurer sa stérilité. L'injection de baclofène dans des flacons peut être utilisée avec une technique aseptique conventionnelle pour remplir les pompes intrathécales avant l'implantation. Des procédures doivent également être en place pour éviter la contamination des surfaces stériles par le contact avec la surface externe non stérile des seringues préremplies lors du remplissage de pompes intrathécales implantables en consultation externe.

Arrêt brutal

Éviter l’arrêt brusque du traitement intrathécal au baclofène. L'arrêt brutal du baclofène intrathécal, quelle que soit sa cause, a provoqué des réactions sévères telles qu'une forte fièvre, une altération de l'état mental, une spasticité exagérée du rebond et une rigidité musculaire qui, dans de rares cas, ont évolué vers la rhabdomyolyse, une défaillance de plusieurs organes du système et la mort. Le priapisme peut également se développer ou se reproduire si le traitement intrathécal est interrompu. La prévention de l’arrêt brutal du baclofène intrathécal nécessite une attention particulière à la programmation et à la surveillance du système de perfusion, au calendrier et aux procédures de remplissage, ainsi qu’aux alarmes de pompe. Les patients et les soignants doivent être informés de l'importance de respecter les visites de renouvellement prévues et doivent être informés des premiers symptômes du sevrage au baclofène. Une attention particulière doit être accordée aux patients à risque (par exemple, lésions de la moelle épinière à T6 ou plus, difficultés de communication, ou antécédents de symptômes de sevrage dus au baclofène oral ou intrathécal). Un diagnostic et un traitement rapides et précis sont importants pour prévenir les effets systémiques du sevrage intrathécal de baclofène sur le système nerveux central, pouvant mettre la vie en danger. Le cas échéant, le baclofène oral et / ou les benzodiazépines orales ou intraveineuses peuvent être envisagés en cas d’urgence.[42609] [42610] Évitez également l’arrêt soudain du baclofène par voie orale après une utilisation chronique; L'arrêt brutal est associé à de la confusion, des hallucinations, d'autres troubles psychiatriques, des convulsions et des exacerbations de la spasticité. Une réduction progressive de la posologie sur une période de 2 semaines ou plus est recommandée.

Administration intrathécale

Une attention particulière doit être accordée à la reconnaissance des signes et des symptômes d’un surdosage de baclofène (voir Effets indésirables), en particulier au cours de la phase initiale de sélection et de titration de la dose de l’administration intrathécale ainsi que lors de la réintroduction du baclofène intrathécal après une période de traitement interrompu. Des symptômes de surdosage en baclofène ont été rapportés chez un adulte sensible recevant un bolus intrathécal de 25 µg.

Paralysie cérébrale, traumatisme crânien, saignement intracrânien, accident vasculaire cérébral

Le baclofène ne doit pas être utilisé chez les patients nécessitant de la spasticité pour maintenir une posture droite et l'équilibre. Bien que l'utilisation intrathécale de baclofène soit indiquée chez les patients présentant une spasticité d'origine cérébrale, le baclofène par voie orale n'est pas recommandé chez les patients présentant des lésions cérébrales, une paralysie cérébrale, un saignement intracrânien, un parkinsonisme ou un accident cérébrovasculaire antérieur. L’efficacité du baclofène par voie orale chez ces patients n’a pas été établie. Le baclofène oral ne traverse la barrière hémato-encéphalique qu'en petites quantités. À fortes doses, le traitement par baclofène par voie orale peut être efficace chez certains patients présentant une spasticité sévère. Chez les patients qui ne répondent pas correctement ou ne tolèrent pas le traitement oral, un essai du traitement intrathécal au baclofène peut être approprié. Les fabricants de baclofène intrathécal recommandent aux patients présentant une spasticité secondaire à un traumatisme à la tête d'attendre au moins un an avant d'envisager un traitement intrathécal au baclofène à long terme; certains cliniciens recommandent de commencer le traitement plus tôt.

Gériatrique

Les patients gériatriques ou présentant des lésions cérébrales par opposition à des lésions de la colonne vertébrale peuvent présenter une toxicité accrue au baclofène. Les patients âgés nécessitent des doses initiales plus faibles et une titration de dose lente. La loi fédérale omnibus sur le rapprochement budgétaire (OBRA) régit l'utilisation des médicaments chez les résidents d'établissements de soins de longue durée. Selon les directives OBRA, la plupart des relaxants musculaires sont mal tolérés par les personnes âgées en raison d'effets secondaires anticholinergiques, de la sédation et / ou d'une faiblesse. Toutefois, une utilisation périodique (par exemple, une fois tous les 3 mois) pendant au plus 7 jours peut être appropriée lorsque d’autres interventions ou médicaments alternatifs ne sont ni efficaces ni indiqués. L'utilisation chronique chez les personnes souffrant de complications dues à la sclérose en plaques, aux lésions de la moelle épinière, à la paralysie cérébrale et à d'autres affections spécifiques peut être indiquée, mais une surveillance étroite est justifiée. L'arrêt brutal de certains relaxants musculaires peut provoquer ou prédisposer les individus à des convulsions ou des hallucinations.

Trouble bipolaire, dépression, psychose, schizophrénie

Les patients présentant des troubles psychiatriques préexistants (par exemple, trouble bipolaire, dépression, psychose, schizophrénie) ont un risque accru de réactions indésirables psychiatriques induites par le baclofène.

Le diabète sucré

L'hyperglycémie est associée à l'utilisation de baclofène par voie orale et intrathécale. Utiliser avec la prudence appropriée chez les patients atteints de diabète sucré.

Trouble convulsif, convulsions

Le baclofène a entraîné une détérioration du contrôle des convulsions et des modifications de l'EEG chez les patients atteints d'épilepsie. Le baclofène doit être prescrit avec prudence aux patients ayant des antécédents de convulsions ou des antécédents de convulsions.

Dialyse, insuffisance rénale, insuffisance rénale

Des cas de toxicité au baclofène (se manifestant par une encéphalopathie, des douleurs abdominales et, dans certains cas, des convulsions et une dépression respiratoire) ont été signalés chez des patients présentant une insuffisance rénale grave (par exemple, une créatinine sérique> 2 mg / dl) et une insuffisance rénale ayant reçu du baclofène par voie orale. On ne s'attend pas à une toxicité similaire avec l'utilisation intrathécale de baclofène car les concentrations plasmatiques du médicament qui en résultent sont 100 fois inférieures à celles observées avec l'utilisation par voie orale. La plupart des patients devenus toxiques ont reçu de faibles doses de baclofène par voie orale (15 à 30 mg / jour, par exemple) pendant une courte période. La toxicité du baclofène peut survenir à des doses relativement faibles dans les 24 à 48 heures suivant le début du traitement par voie orale. Chez les patients insuffisants rénaux sous dialyse, des doses ne dépassant pas 5 mg / jour par voie orale ont été suggérées; bien que la toxicité peut encore se produire. Par conséquent, chez les patients présentant une insuffisance rénale sévère ou une insuffisance rénale, des thérapies alternatives doivent être envisagées. Si un patient développe une toxicité au baclofène, l'hémodialyse peut être un traitement utile pour soulager les symptômes cliniques.

Administration concomitante avec d'autres dépresseurs du système nerveux central, machines conduisant ou opérant, ingestion d'éthanol

Les patients doivent être avertis que le baclofène peut nuire à la capacité d'accomplir certaines tâches nécessitant de la vigilance ou une coordination physique, comme conduire ou faire fonctionner des machines. Les patients doivent également être avertis du fait que les effets dépresseurs du baclofène sur le système nerveux central (SNC) peuvent s'ajouter à ceux de l'ingestion d'éthanol et de la coadministration avec d'autres dépresseurs du SNC.

Enfants, nourrissons

Le fabricant indique que la sécurité n'a pas été établie pour le baclofène oral chez les nourrissons et les enfants de moins de 12 ans, ni pour le baclofène intrathécal chez les enfants de moins de 4 ans. Les enfants subissant une implantation par pompe pour un traitement intrathécal au baclofène doivent avoir une masse corporelle suffisante pour accueillir la pompe.

Administration épidurale, administration intramusculaire, administration intraveineuse, administration sous-cutanée

Le baclofène intrathécal doit être administré via des dispositifs de perfusion approuvés par la FDA ou en injections intrathécales simples. Le baclofène ne doit pas être administré par voie intraveineuse, intramusculaire, sous-cutanée ou épidurale. Les médecins doivent être formés au traitement par pompe intrathécale en raison du risque de dépression du système nerveux central, de collapsus cardiovasculaire ou d'insuffisance respiratoire. La pompe ne doit pas être implantée avant l'évaluation de la réponse du patient au processus de dépistage. Les patients qui ne répondent pas à un bol intrathécal de 100 µg ne doivent pas être considérés comme candidats à une pompe implantée pour perfusion chronique. Les patients doivent être étroitement surveillés jusqu'à ce que la réponse initiale du patient soit stable et après chaque ajustement. Les médicaments antispasmodiques oraux concomitants doivent être interrompus avant l'implantation du dispositif de perfusion pour éviter les interactions médicamenteuses ou la toxicité. Évitez l’arrêt brusque de tout agent antispasmodique.

Traitement anticoagulant, coagulopathie, infection, thrombocytopénie

Avant le test de dépistage et le traitement par injection de baclofène, les patients ne devaient pas présenter les conditions suivantes: infection au site d’injection, bactériémie documentée, anomalies plaquettaires, thrombocytopénie <100 000 / mm3, augmentation du temps de saignement, coagulopathie non contrôlée, traitement anticoagulant, présence de tumeur au site d'injection et à tout autre traitement médicamenteux ou à tout autre problème médical pouvant contre-indiquer l'administration de baclofène par cette voie.

Maladie dentaire

Pendant le traitement intrathécal chronique au baclofène, les patients présentant une maladie dentaire peuvent présenter un risque accru de développer une carie, une maladie parodontale ou une candidose buccale en raison d'une diminution du flux salivaire.

Grossesse

Il n’existe aucune étude adéquate et bien contrôlée sur l’utilisation du baclofène au cours de la grossesse. D'après les données chez l'animal, le baclofène peut être nocif pour le fœtus. Le baclofène ne doit être utilisé pendant la grossesse que lorsque le bénéfice potentiel pour la mère l'emporte sur le risque potentiel pour le fœtus. Au cours de l'administration de baclofène à des animaux au cours de l'organogenèse à des doses dépassant la dose maximale recommandée chez l'homme (MRHD), on a constaté une incidence accrue d'omphalocèles (hernie ventrale), d'ossification sternebrale incomplète et / ou de noyaux phalangiens non désossés des membres antérieurs et postérieurs. Une réduction du poids fœtal moyen, entraînant des retards dans l'ossification du squelette, a également été observée. Les données humaines sont limitées. Dans 3 cas, des nourrissons en bonne santé ont été accouchés par césarienne après une exposition in utero à des perfusions intrathécales de baclofène (doses de 140 à 1 400 µg / jour). Le suivi dans 2 des cas a révélé un développement normal à l'âge de 12 et 24 mois, respectivement. Un syndrome d’abstinence néonatale peut survenir peu de temps après la naissance chez les nouveau-nés à la suite d’une exposition intra-utérine au baclofène. Dans 1 rapport de cas, une femme a reçu 80 mg de baclofène par voie orale quotidiennement pendant et après la grossesse. Afin de prévenir le NAS, le nouveau-né a été placé sous baclofène par voie orale à la dose initiale de 0,1 mg / kg / jour pendant 4 jours, puis a diminué quotidiennement de 0,01 mg / kg / jour jusqu'à l'arrêt du médicament au bout de 13 jours. Il est à noter que le nouveau-né a reçu environ un tiers de la dose quotidienne totale de baclofène contenue dans le lait maternel. Les évaluations quotidiennes pour NAS ont été effectuées à l'aide du système de notation Finnegan modifié. Une intervention pharmacologique supplémentaire n'était pas nécessaire et le nouveau-né était sorti 3 jours après la fin de la période de défilement. Les effets du baclofène sur le travail et l'accouchement obstétrical sont inconnus.

Allaitement maternel

Aux doses orales thérapeutiques, le baclofène est excrété dans le lait maternel; la prudence est recommandée lors de l'utilisation du médicament pendant l'allaitement. Cependant, on ignore si le baclofène est décelable dans le lait maternel après une administration intrathécale. L'étiquetage des produits intrathécaux recommande de prendre la décision d'interrompre l'allaitement ou de cesser l'injection intrathécale de baclofène, en tenant compte de l'importance du traitement intrathécal au baclofène pour la mère. Des informations limitées indiquent que le baclofène administré par voie orale à la mère allaitante apparaît à de faibles concentrations dans le lait et ne devrait pas entraîner d'effets indésirables chez le nourrisson allaité, en particulier s'il est âgé de plus de 2 mois. Surveillez les nouveau-nés pour détecter les signes de sédation. De faibles doses intrathécales et une application topique n’affecteront probablement pas le nourrisson allaité. Chez une femme qui a reçu une dose orale unique de 20 mg de baclofène par voie orale 14 jours après l'accouchement, la concentration sérique la plus élevée du médicament s'est produite à 3 heures et la concentration la plus élevée dans le lait à 4 heures. La quantité totale de médicament récupéré dans le lait au cours de la période d'échantillonnage de 26 heures était d'environ 0,1% de la dose ingérée par la mère. Si le traitement au baclofène est poursuivi, surveillez la sédation chez le nourrisson.

Phénylcétonurie

Les comprimés à dissolution de baclofène (Kemstro) peuvent contenir de l’aspartame, une source de phénylalanine. Utilisez de telles formulations avec prudence chez les patients atteints de phénylcétonurie.

Kyste de l'ovaire

Une augmentation liée à la dose de l'incidence de kyste ovarien et une augmentation moins marquée du gonflement des glandes surrénales et / ou hémorragiques ont été observées chez des rates traitées de façon chronique au baclofène. Des kystes ovariens ont été découverts par palpation chez environ 4% des patientes atteintes de sclérose en plaques traitées au baclofène pendant une période maximale d'un an. Dans la plupart des cas, ces kystes ont disparu spontanément pendant que les patients continuaient à recevoir le médicament. Ovarian cysts are estimated to occur spontaneously in approximately 1% to 5% of the normal female population.

ADVERSE REACTIONS

Sévère

coma / Early / 0-1.5
stroke / Early / Incidence not known
seizures / Delayed / Incidence not known
suicidal ideation / Delayed / Incidence not known
ileus / Delayed / Incidence not known
oliguria / Early / Incidence not known
renal failure (unspecified) / Delayed / Incidence not known
bronchospasm / Rapid / Incidence not known
bradycardia / Rapid / Incidence not known
ventricular tachycardia / Early / Incidence not known
thrombosis / Delayed / Incidence not known
malignant hyperthermia / Rapid / Incidence not known
disseminated intravascular coagulation (DIC) / Delayed / Incidence not known
rhabdomyolysis / Delayed / Incidence not known
neuroleptic malignant syndrome / Delayed / Incidence not known
pulmonary embolism / Delayed / Incidence not known
apnea / Delayed / Incidence not known

Modéré

hypotonia / Delayed / 2.4-34.7
confusion / Early / 0.5-11.0
hypotension / Rapid / 0-9.0
urinary retention / Early / 0.7-8.0
hypertonia / Delayed / 0-6.0
constipation / Delayed / 0.2-6.0
hypoventilation / Rapid / 0.2-4.0
peripheral edema / Delayed / 0-3.3
urinary incontinence / Early / 0-2.0
depression / Delayed / 0-1.6
impotence (erectile dysfunction) / Delayed / 0.2-1.6
impaired cognition / Early / 0.5-1.3
dyspnea / Early / 0-1.2
hypertension / Early / 0.2-0.6
hallucinations / Early / 0.3-0.5
dyskinesia / Delayed / Incidence not known
dystonic reaction / Delayed / Incidence not known
nystagmus / Delayed / Incidence not known
dysarthria / Delayed / Incidence not known
euphoria / Early / Incidence not known
respiratory depression / Rapid / Incidence not known
encephalopathy / Delayed / Incidence not known
psychological dependence / Delayed / Incidence not known
ataxia / Delayed / Incidence not known
blurred vision / Early / Incidence not known
amnesia / Delayed / Incidence not known
psychosis / Early / Incidence not known
akathisia / Delayed / Incidence not known
hyperglycemia / Delayed / Incidence not known
vaginitis / Delayed / Incidence not known
ejaculation dysfunction / Delayed / Incidence not known
hematuria / Delayed / Incidence not known
dysuria / Early / Incidence not known
skin ulcer / Delayed / Incidence not known
QT prolongation / Rapid / Incidence not known
orthostatic hypotension / Delayed / Incidence not known
palpitations / Early / Incidence not known
chest pain (unspecified) / Early / Incidence not known
meningitis / Delayed / Incidence not known
priapism / Early / Incidence not known
withdrawal / Early / Incidence not known
anemia / Delayed / Incidence not known

Doux

drowsiness / Early / 5.7-63.0
weakness / Early / 5.0-15.0
dizziness / Early / 1.7-15.0
headache / Early / 1.6-10.7
nausea / Early / 1.4-10.5
vomiting / Early / 1.6-10.5
insomnia / Early / 0-7.0
paresthesias / Delayed / 0.7-6.7
increased urinary frequency / Early / 0-6.0
pruritus / Rapid / 0-4.0
xerostomia / Early / 0-3.3
hypersalivation / Early / 0-2.7
diarrhea / Early / 0-2.3
back pain / Delayed / 0.7-2.0
asthenia / Delayed / 0-2.0
agitation / Early / 0.5-1.3
tremor / Early / 0-1.3
chills / Rapid / 0-1.3
urticaria / Rapid / 0.2-1.2
abdominal pain / Early / 0-1.0
anxiety / Delayed / 0.2-0.9
diplopia / Early / 0-0.9
anorexia / Delayed / 0-0.9
musculoskeletal pain / Early / Incidence not known
hyporeflexia / Delayed / Incidence not known
emotional lability / Early / Incidence not known
miosis / Early / Incidence not known
mydriasis / Early / Incidence not known
paranoia / Early / Incidence not known
tinnitus / Delayed / Incidence not known
dyspepsia / Early / Incidence not known
weight gain / Delayed / Incidence not known
flatulence / Early / Incidence not known
dysgeusia / Early / Incidence not known
nocturia / Early / Incidence not known
libido decrease / Delayed / Incidence not known
orgasm dysfunction / Delayed / Incidence not known
alopecia / Delayed / Incidence not known
diaphoresis / Early / Incidence not known
rash / Early / Incidence not known
premature atrial contractions (PACs) / Early / Incidence not known
influenza / Delayed / Incidence not known
hypothermia / Delayed / Incidence not known
malaise / Early / Incidence not known
leukocytosis / Delayed / Incidence not known
nasal congestion / Early / Incidence not known
rhinitis / Early / Incidence not known
hyperventilation / Early / Incidence not known

DRUG INTERACTIONS

Acebutolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Acetaminophen; Butalbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Acetaminophen; Butalbital; Caffeine: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Acetaminophen; Butalbital; Caffeine; Codeine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Acetaminophen; Caffeine; Dihydrocodeine: (Major) Concomitant use of dihydrocodeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Acetaminophen; Codeine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Acetaminophen; Dichloralphenazone; Isometheptene: (Moderate) Additive CNS depression is possible if skeletal muscle relaxants are used concomitantly with other CNS depressants. Dosage adjustments of one or both medications may be necessary.
Acetaminophen; Hydrocodone: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Acetaminophen; Oxycodone: (Major) Concomitant use of oxycodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Acetaminophen; Pentazocine: (Moderate) Use pentazocine with caution in any patient receiving medication with CNS depressant and/or anticholinergic activity. Coadministration of pentazocine with skeletal muscle relaxants may result in additive respiratory and CNS depression and anticholinergic effects, such as urinary retention and constipation.
Acetaminophen; Tramadol: (Major) Concomitant use of tramadol with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Alfentanil: (Major) Concomitant use of opiate agonists with skeletal muscle relaxants may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with skeletal muscle relaxants to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If an opiate agonist is initiated in a patient taking a skeletal muscle relaxant, use a lower initial dose of the opiate and titrate to clinical response. If a skeletal muscle relaxant is prescribed for a patient taking an opiate agonist, use a lower initial dose of the skeletal muscle relaxant and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation.
Aliskiren; Amlodipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Alprazolam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Amiloride: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amitriptyline; Chlordiazepoxide: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Amlodipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amlodipine; Atorvastatin: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amlodipine; Benazepril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amlodipine; Olmesartan: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amlodipine; Telmisartan: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amlodipine; Valsartan: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Amobarbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Amoxapine: (Moderate) Skeletal muscle relaxants should be combined cautiously with cyclic antidepressants like amoxapine because they could cause additive CNS depressant effects. Skeletal muscle relaxants may produce additive CNS depression or other additive effects when combined with tricyclic antidepressants. Depending on the specific agent (e.g., cyclobenzaprine, and orphenadrine), additive anticholinergic effects may also be seen. Clinicians should note that antimuscarinic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Patients should be monitored for excessive adverse effects from either agent.
Angiotensin II receptor antagonists: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Angiotensin-converting enzyme inhibitors: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Anxiolytics; Sedatives; and Hypnotics: (Moderate) Concurrent use of baclofen and CNS depressants such as certain sedatives or hypnotics can cause additive CNS depression. A reduction in the dose of these medications may be considered to minimize additive sedative effects, if they occur. With hypnotic medications, the risk of next-day psychomotor impairment is increased during co-administration of other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.
Apomorphine: (Moderate) Apomorphine causes significant somnolence. Concomitant administration of apomorphine and CNS depressants could result in additive depressant effects.
Aspirin, ASA; Butalbital; Caffeine: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Aspirin, ASA; Caffeine; Dihydrocodeine: (Major) Concomitant use of dihydrocodeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Aspirin, ASA; Carisoprodol; Codeine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Aspirin, ASA; Oxycodone: (Major) Concomitant use of oxycodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Atenolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Atenolol; Chlorthalidone: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Atracurium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Atropine; Difenoxin: (Moderate) Concurrent administration of diphenoxylate/difenoxin with baclofen can potentiate the CNS-depressant effects of diphenoxylate/difenoxin. Use caution during coadministration.
Atropine; Diphenoxylate: (Moderate) Concurrent administration of diphenoxylate/difenoxin with baclofen can potentiate the CNS-depressant effects of diphenoxylate/difenoxin. Use caution during coadministration.
Atropine; Hyoscyamine; Phenobarbital; Scopolamine: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Azelastine: (Moderate) An enhanced CNS depressant effect may occur when azelastine is combined with other CNS depressants including skeletal muscle relaxants.
Azelastine; Fluticasone: (Moderate) An enhanced CNS depressant effect may occur when azelastine is combined with other CNS depressants including skeletal muscle relaxants.
Bacitracin: (Minor) Use skeletal muscle relaxants cautiously in patients receiving systemic bacitracin. If bacitracin is administered parenterally during surgery, there may be increased skeletal muscle relaxation, and postoperative use may reinstate neuromuscular blockade.
Barbiturates: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Belladonna Alkaloids; Ergotamine; Phenobarbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Belladonna; Opium: (Major) Concomitant use of opium with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Benazepril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Bendroflumethiazide; Nadolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Benzodiazepines: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Beta-adrenergic blockers: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Betaxolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Bisoprolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Botulinum Toxins: (Moderate) Excessive neuromuscular weakness may be exacerbated by coadministration of a botulinum toxin with skeletal muscle relaxants. Advise patients to seek medical assistance if they develop any unusual symptoms (including difficulty with swallowing, speaking, or breathing or walking), or if any existing symptom worsens during use of a botulinum toxin.
Brimonidine; Timolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Brompheniramine; Guaifenesin; Hydrocodone: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Brompheniramine; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Buprenorphine: (Moderate) Concomitant use of buprenorphine with other CNS depressants can lead to additive CNS depressive effects. Hypotension, profound sedation, coma, respiratory depression, or death may occur; examples of other CNS depressants can include skeletal muscle relaxants, like baclofen. Prior to concurrent use of buprenorphine in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Consider the patient's use of alcohol or illicit drugs. A dose reduction of one or both drugs may be warranted. It is recommended that the injectable buprenorphine dose be halved for patients who receive other drugs with CNS depressant effects; for the buprenorphine transdermal patch, start with the 5 mcg/hour patch. Monitor patients for sedation or respiratory depression.
Buprenorphine; Naloxone: (Moderate) Concomitant use of buprenorphine with other CNS depressants can lead to additive CNS depressive effects. Hypotension, profound sedation, coma, respiratory depression, or death may occur; examples of other CNS depressants can include skeletal muscle relaxants, like baclofen. Prior to concurrent use of buprenorphine in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Consider the patient's use of alcohol or illicit drugs. A dose reduction of one or both drugs may be warranted. It is recommended that the injectable buprenorphine dose be halved for patients who receive other drugs with CNS depressant effects; for the buprenorphine transdermal patch, start with the 5 mcg/hour patch. Monitor patients for sedation or respiratory depression.
Buspirone: (Moderate) Concomitant use of skeletal muscle relaxants with buspirone can result in additive CNS depression. Dosage adjustments of either or both medications may be necessary.
Butabarbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Butorphanol: (Moderate) Concomitant use of butorphanol with other CNS depressants, such as baclofen, can potentiate the effects of butorphanol on respiratory depression, CNS depression, and sedation.
Calcium-channel blockers: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Cannabidiol: (Moderate) Monitor for excessive sedation and somnolence during coadministration of cannabidiol and baclofen. CNS depressants can potentiate the effects of cannabidiol.
Captopril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Carbetapentane; Chlorpheniramine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Chlorpheniramine; Phenylephrine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Diphenhydramine; Phenylephrine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Guaifenesin: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Guaifenesin; Phenylephrine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Phenylephrine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Phenylephrine; Pyrilamine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Pseudoephedrine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbetapentane; Pyrilamine: (Moderate) Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including skeletal muscle relaxants.
Carbidopa; Levodopa; Entacapone: (Moderate) COMT inhibitors should be given cautiously with other agents that cause CNS depression, including skeletal muscle relaxants, due to the possibility of additive sedation.
Carbinoxamine; Hydrocodone; Phenylephrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Carbinoxamine; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Carteolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Carvedilol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Central-acting adrenergic agents: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Chloral Hydrate: (Moderate) Concurrent use of baclofen and CNS depressants such as certain sedatives or hypnotics can cause additive CNS depression. A reduction in the dose of these medications may be considered to minimize additive sedative effects, if they occur. With hypnotic medications, the risk of next-day psychomotor impairment is increased during co-administration of other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.
Chlordiazepoxide: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Chlordiazepoxide; Clidinium: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Chlorpheniramine; Codeine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Major) Concomitant use of dihydrocodeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: (Major) Concomitant use of dihydrocodeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Chlorpheniramine; Hydrocodone: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Chlorpheniramine; Hydrocodone; Phenylephrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Chlorpheniramine; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Chlorpromazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Cisatracurium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Clevidipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Clonazepam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Clorazepate: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Clozapine: (Moderate) Skeletal muscle relaxants should be combined cautiously with clozapine because they could cause additive depressant effects and possible respiratory depression or hypotension.
Codeine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Codeine; Guaifenesin: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Codeine; Phenylephrine; Promethazine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) Because promethazine causes pronounced sedation, an enhanced CNS depressant effect or additive drowsiness may occur when it is combined with other CNS depressants including skeletal muscle relaxants like baclofen.
Codeine; Promethazine: (Major) Concomitant use of codeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) Because promethazine causes pronounced sedation, an enhanced CNS depressant effect or additive drowsiness may occur when it is combined with other CNS depressants including skeletal muscle relaxants like baclofen.
COMT inhibitors: (Moderate) COMT inhibitors should be given cautiously with other agents that cause CNS depression, including skeletal muscle relaxants, due to the possibility of additive sedation.
Deutetrabenazine: (Moderate) Advise patients that concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as baclofen, may have additive effects and worsen drowsiness or sedation.
Dexmedetomidine: (Moderate) Due to the anesthetic effects of dexmedetomidine, concurrent use with other CNS depressants, such as skeletal muscle relaxants, could result in additive sedative effects and possibly prolong recovery from anesthesia. Dosage adjustments of either or both medications may be necessary.
Dextromethorphan; Promethazine: (Moderate) Because promethazine causes pronounced sedation, an enhanced CNS depressant effect or additive drowsiness may occur when it is combined with other CNS depressants including skeletal muscle relaxants like baclofen.
Diazepam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Dihydrocodeine; Guaifenesin; Pseudoephedrine: (Major) Concomitant use of dihydrocodeine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Diltiazem: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Diphenhydramine; Hydrocodone; Phenylephrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Dorzolamide; Timolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Doxacurium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Doxazosin: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Dronabinol: (Moderate) Concomitant use of skeletal muscle relaxants with dronabinol can result in additive CNS depression and dizziness, which can impair the ability to undertake tasks requiring mental alertness. Utilize appropriate caution if these drugs are given together.
Droperidol: (Moderate) Concomitant use of baclofen with other CNS depressants like droperidol can result in additive CNS depression.
Enalapril, Enalaprilat: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Enalapril; Felodipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Enflurane: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Entacapone: (Moderate) COMT inhibitors should be given cautiously with other agents that cause CNS depression, including skeletal muscle relaxants, due to the possibility of additive sedation.
Eplerenone: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Epoprostenol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Esmolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Estazolam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Eszopiclone: (Moderate) Concurrent use of baclofen and CNS depressants such as certain sedatives or hypnotics can cause additive CNS depression. A reduction in the dose of these medications may be considered to minimize additive sedative effects, if they occur. With hypnotic medications, the risk of next-day psychomotor impairment is increased during co-administration of other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.
Ethanol: (Moderate) Concomitant use of baclofen with other CNS depressants like alcohol can result in additive CNS depression.
Etomidate: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Felodipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Fentanyl: (Major) Concomitant use of fentanyl with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Fluphenazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Flurazepam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Fosinopril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Fospropofol: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
General anesthetics: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Guaifenesin; Hydrocodone: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Halothane: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Homatropine; Hydrocodone: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Hydrochlorothiazide, HCTZ; Lisinopril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Hydrochlorothiazide, HCTZ; Metoprolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Hydrochlorothiazide, HCTZ; Propranolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Hydrochlorothiazide, HCTZ; Quinapril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Hydrochlorothiazide, HCTZ; Spironolactone: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Hydrochlorothiazide, HCTZ; Triamterene: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Hydrocodone: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Hydrocodone; Ibuprofen: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Hydrocodone; Phenylephrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Hydrocodone; Potassium Guaiacolsulfonate: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Hydrocodone; Pseudoephedrine: (Major) Concomitant use of hydrocodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Avoid prescribing opioid cough medications in patients taking a skeletal muscle relaxant. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Hydromorphone: (Major) Concomitant use of hydromorphone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Ibuprofen; Oxycodone: (Major) Concomitant use of oxycodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Iloprost: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Isoflurane: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Isradipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Kava Kava, Piper methysticum: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants, such as kava kava can result in additive CNS depression. Persons taking other CNS-active medications such as, skeletal muscle relaxants, should discuss the use of herbal supplements with their health care professional prior to consuming kava kava. Patients should not abruptly stop taking their prescribed medications.
Ketamine: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Labetalol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Levobetaxolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Levobunolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Levorphanol: (Major) Concomitant use of levorphanol with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Reduce the initial dose of levorphanol by approximately 50% or more. Educate patients about the risks and symptoms of respiratory depression and sedation.
Lisinopril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Lofexidine: (Moderate) Monitor for additive sedation during coadministration of lofexidine and baclofen. Lofexidine can potentiate the effects of CNS depressants. Patients should be advised to avoid driving or performing any other tasks requiring mental alertness until the effects of the combination are known. In the use of intrathecal baclofen, hypotension is possible, so the additive effects of lofexidine on blood pressure should be considered. Carefully monitor blood pressure and heart rate in such patients.
Loop diuretics: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Lorazepam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Loxapine: (Moderate) Simultaneous use of skeletal muscle relaxants and other CNS depressants, such as antipsychotics, can increase CNS depression.
Maprotiline: (Moderate) Skeletal muscle relaxants should be combined cautiously with cyclic antidepressants like maprotiline because they could cause additive CNS depressant effects. Depending on the specific agent (e.g., cyclobenzaprine, and orphenadrine), additive anticholinergic effects may also be seen. Clinicians should note that antimuscarinic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Patients should be monitored for excessive adverse effects from either agent.
Mepenzolate: (Moderate) CNS depression can be increased when mepenzolate is combined with other CNS depressants such as skeletal muscle relaxants.
Meperidine: (Major) Concomitant use of meperidine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Meperidine; Promethazine: (Major) Concomitant use of meperidine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation. (Moderate) Because promethazine causes pronounced sedation, an enhanced CNS depressant effect or additive drowsiness may occur when it is combined with other CNS depressants including skeletal muscle relaxants like baclofen.
Mephobarbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Meprobamate: (Moderate) Concurrent use of baclofen and CNS depressants such as certain sedatives or hypnotics can cause additive CNS depression. A reduction in the dose of these medications may be considered to minimize additive sedative effects, if they occur. With hypnotic medications, the risk of next-day psychomotor impairment is increased during co-administration of other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.
Mesoridazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Methadone: (Major) Concomitant use of methadone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Methocarbamol: (Moderate) Concomitant use of baclofen with other CNS depressants can result in additive CNS depression.
Methohexital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Methscopolamine: (Moderate) CNS depression can be increased when methscopolamine is combined with other CNS depressants such as skeletal muscle relaxants.
Metoprolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Midazolam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Mirtazapine: (Moderate) Skeletal muscle relaxants like baclofen may cause additive CNS depression if used concomitantly with other drugs with CNS depressant properties such as mirtazapine. Combination therapy may amplify sedation and dizziness, which can impair the patient's ability to perform tasks requiring mental alertness. Dosage adjustments of either or both medications may be necessary in some instances.
Mivacurium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Moexipril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Molindone: (Moderate) Simultaneous use of skeletal muscle relaxants and other CNS depressants, such as molindone, can increase CNS depression. In addition, antipsychotics are associated with anticholinergic effects; therefore, additive effects may be seen during concurrent use of molindone and other drugs having anticholinergic activity. Clinicians should note that antimuscarinic effects may be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation.
Morphine: (Major) Concomitant use of morphine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. For extended-release morphine tablets (MS Contin and Morphabond), start with 15 mg every 12 hours. Morphine; naltrexone should be initiated at 1/3 to 1/2 the recommended starting dosage. Educate patients about the risks and symptoms of respiratory depression and sedation.
Morphine; Naltrexone: (Major) Concomitant use of morphine with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. For extended-release morphine tablets (MS Contin and Morphabond), start with 15 mg every 12 hours. Morphine; naltrexone should be initiated at 1/3 to 1/2 the recommended starting dosage. Educate patients about the risks and symptoms of respiratory depression and sedation.
Nabilone: (Moderate) Concomitant use of nabilone with other CNS depressants like skeletal muscle relaxants can potentiate the effects of nabilone on respiratory depression, sedation and dizziness, which can impair the ability to undertake tasks requiring mental alertness.
Nadolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Nalbuphine: (Moderate) Concomitant use of nalbuphine with other CNS depressants, such as skeletal muscle relaxants, can potentiate the effects of nalbuphine on respiratory depression, CNS depression, and sedation.
Nebivolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Nebivolol; Valsartan: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Neuromuscular blockers: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Nicardipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Nifedipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Nimodipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Nisoldipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Oxazepam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Oxycodone: (Major) Concomitant use of oxycodone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Oxymorphone: (Major) Concomitant use of oxymorphone with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Reduce the initial oxymorphone dosage by 1/3 to 1/2. Educate patients about the risks and symptoms of respiratory depression and sedation.
Pancuronium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Penbutolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Pentazocine: (Moderate) Use pentazocine with caution in any patient receiving medication with CNS depressant and/or anticholinergic activity. Coadministration of pentazocine with skeletal muscle relaxants may result in additive respiratory and CNS depression and anticholinergic effects, such as urinary retention and constipation.
Pentazocine; Naloxone: (Moderate) Use pentazocine with caution in any patient receiving medication with CNS depressant and/or anticholinergic activity. Coadministration of pentazocine with skeletal muscle relaxants may result in additive respiratory and CNS depression and anticholinergic effects, such as urinary retention and constipation.
Pentobarbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Perindopril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Perindopril; Amlodipine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Perphenazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Perphenazine; Amitriptyline: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Phenobarbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Phenothiazines: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Phenoxybenzamine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Phentolamine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Phenylephrine; Promethazine: (Moderate) Because promethazine causes pronounced sedation, an enhanced CNS depressant effect or additive drowsiness may occur when it is combined with other CNS depressants including skeletal muscle relaxants like baclofen.
Pindolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Potassium-sparing diuretics: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Prazosin: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Primidone: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Prochlorperazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Promethazine: (Moderate) Because promethazine causes pronounced sedation, an enhanced CNS depressant effect or additive drowsiness may occur when it is combined with other CNS depressants including skeletal muscle relaxants like baclofen.
Propofol: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Propranolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Quazepam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Quinapril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Ramipril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Rapacuronium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Remifentanil: (Major) Concomitant use of opiate agonists with skeletal muscle relaxants may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with skeletal muscle relaxants to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If an opiate agonist is initiated in a patient taking a skeletal muscle relaxant, use a lower initial dose of the opiate and titrate to clinical response. If a skeletal muscle relaxant is prescribed for a patient taking an opiate agonist, use a lower initial dose of the skeletal muscle relaxant and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation.
Reserpine: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Rocuronium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Secobarbital: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Sedating H1-blockers: (Moderate) An enhanced CNS depressant effect may occur when sedating H1-blockers are combined with other CNS depressants including skeletal muscle relaxants, such as baclofen.
Sevoflurane: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants like general anesthetics can result in additive CNS depression.
Sodium Oxybate: (Major) Sodium oxybate should not be used in combination with CNS depressant anxiolytics, sedatives, and hypnotics or other sedative CNS depressant drugs. Additive CNS depressant effects may be possible when sodium oxybate is used concurrently with skeletal muscle relaxants.
Spironolactone: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Succinylcholine: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Sufentanil: (Major) Concomitant use of opiate agonists with skeletal muscle relaxants may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with skeletal muscle relaxants to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If an opiate agonist is initiated in a patient taking a skeletal muscle relaxant, use a lower initial dose of the opiate and titrate to clinical response. If a skeletal muscle relaxant is prescribed for a patient taking an opiate agonist, use a lower initial dose of the skeletal muscle relaxant and titrate to clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation.
Tapentadol: (Major) Concomitant use of tapentadol with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Temazepam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Terazosin: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Thalidomide: (Major) Avoid the concomitant use of thalidomide with other central nervous system depressants such as skeletal muscle relaxants due to the potential for additive sedative effects.
Thiazide diuretics: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Thiethylperazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Thiopental: (Moderate) Additive CNS depression may occur if barbiturates are used concomitantly with skeletal muscle relaxants. Caution should be exercised during concomitant use of skeletal muscle relaxants and barbiturates; dosage reduction of one or both agents may be necessary.
Thioridazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Thiothixene: (Moderate) Thiothixene can potentiate the CNS-depressant action of other drugs, such skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Timolol: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Tizanidine: (Moderate) Concurrent use of tizanidine and CNS depressants, such as baclofen, can cause additive CNS depression.
Tolcapone: (Moderate) COMT inhibitors should be given cautiously with other agents that cause CNS depression, including skeletal muscle relaxants, due to the possibility of additive sedation.
Tramadol: (Major) Concomitant use of tramadol with a skeletal muscle relaxant may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opioid pain medications with a skeletal muscle relaxant to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Educate patients about the risks and symptoms of respiratory depression and sedation.
Trandolapril: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required
Trandolapril; Verapamil: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Trazodone: (Moderate) CNS depressants, such as baclofen, should be used cautiously in patients receiving trazodone because of additive CNS-depressant effects, including possible respiratory depression or hypotension. A dose reduction of one or both drugs may be warranted.
Treprostinil: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Triamterene: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Triazolam: (Moderate) Concomitant use of skeletal muscle relaxants with benzodiazepines can result in additive CNS depression. The severity of this interaction may be increased when additional CNS depressants are given.
Tricyclic antidepressants: (Moderate) Concomitant use of baclofen with other CNS depressants, such as tricyclic antidepressants, can result in additive CNS depression. In addition, simultaneous use of baclofen and tricyclic antidepressants may cause muscle hypotonia.
Trifluoperazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as skeletal muscle relaxants. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension.
Tubocurarine: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Valerian, Valeriana officinalis: (Moderate) Concomitant use of baclofen with the phytomedicinals valerian, Valeriana officinalis can result in additive CNS depression.
Vasodilators: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Vecuronium: (Moderate) Concomitant use of skeletal muscle relaxants with other CNS depressants can result in additive CNS depression. Also, dantrolene may potentiate neuromuscular block.
Verapamil: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
Zaleplon: (Moderate) Concurrent use of baclofen and CNS depressants such as certain sedatives or hypnotics can cause additive CNS depression. A reduction in the dose of these medications may be considered to minimize additive sedative effects, if they occur. With hypnotic medications, the risk of next-day psychomotor impairment is increased during co-administration of other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.
Ziprasidone: (Moderate) Ziprasidone has the potential to impair cognitive and motor skills. Additive CNS depressant effects are possible when ziprasidone is used concurrently with any CNS depressant, including baclofen.
Zolpidem: (Moderate) Concurrent use of baclofen and CNS depressants such as certain sedatives or hypnotics can cause additive CNS depression. A reduction in the dose of these medications may be considered to minimize additive sedative effects, if they occur. With hypnotic medications, the risk of next-day psychomotor impairment is increased during co-administration of other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.

PREGNANCY AND LACTATION

Pregnancy

There are no adequate and well controlled studies of baclofen use during human pregnancy. Based on animal data, baclofen may cause fetal harm. Baclofen should only be used during pregnancy when the potential benefit to the mother outweighs the potential risk to the fetus. During administration of baclofen to animals during organogenesis at doses exceeding the maximum recommended human dose (MRHD), there were increased incidences of omphaloceles (ventral hernias), incomplete sternebral ossification, and/or unossified phalangeal nuclei of forelimbs and hindlimbs. A reduction in mean fetal weight with consequent delays in skeletal ossification was also observed. Human data are limited. In 3 cases, healthy infants were delivered by C-section after in utero exposure to intrathecal baclofen infusions (doses of 140 to 1,400 mcg/day). Follow up in 2 of the cases revealed normal development at 12 months and 24 months of age, respectively. A neonatal abstinence syndrome may occur shortly after birth in neonates following intrauterine baclofen exposure. In 1 case report, a woman received 80 mg of oral baclofen daily during pregnancy and post-partum. In order to prevent NAS, the neonate was placed on oral baclofen at initial dosage of 0.1 mg/kg/day for 4 days, followed by a daily decrease of 0.01 mg/kg/day until the drug was discontinued after 13 days. Of note, the neonate received approximately one-third of the total daily dose of baclofen from breast milk. Daily assessments for NAS were done using the modified Finnegan scoring system. Additional pharmacological intervention was not needed, and the neonate was discharged 3 days after the taper ended. The effects of baclofen in labor and obstetric delivery are unknown.

At therapeutic oral doses, baclofen is excreted in human milk; caution is recommended when using the drug during breast-feeding. However, it is not known if baclofen is detectable in breast milk after intrathecal administration; the labeling for intrathecal products recommends that a decision be made whether to discontinue breast-feeding or to discontinue intrathecal baclofen injection, considering the importance of intrathecal baclofen therapy to the mother. Limited information indicates that oral baclofen to the lactating mother appears in low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor newborn infants for signs of sedation. Low intrathecal doses and topical application are unlikely to affect the nursing infant. In a woman who received a single 20 mg oral dose of baclofen 14 days postpartum, the highest serum concentration of the drug occurred at 3 hours and the highest milk level was obtained at 4 hours. The total amount of drug recovered from the milk during the 26-hour sampling period was about 0.1% of the maternally ingested dose. If baclofen treatment is continued, monitor the nursing infant for sedation.

MECHANISM OF ACTION

Baclofen's mechanism of action is not fully understood, but it is believed that the drug works mainly at the level of the spinal cord to block polysynaptic afferent pathways and, to a lesser extent, monosynaptic afferent pathways. Baclofen may inhibit the transmission of impulses through these pathways by acting as an inhibitory neurotransmitter itself or by hyperpolarizing the primary afferent nerve terminals, which inhibits the release of excitatory neurotransmitters such as glutamate and aspartic acids. Because large doses of baclofen cause CNS depression, it is postulated that the drug works at supraspinal sites as well. Baclofen has been described as a gamma-aminobutyric acid (GABA) agonist; the drug stimulates the GABA-B receptor. This leads to a decreased release of the neurotransmitters aspartate and glutamate and decreased excitatory input into alpha-motor neurons.

PHARMACOKINETICS

Baclofen is given orally or intrathecally. Baclofen crosses the placenta and is excreted into breast milk. Protein binding is low (roughly 30%). Approximately 15% of a baclofen dose is metabolized in the liver, mostly by deamination. The serum half-life ranges from 2.5—4 hours. The kidney excretes 70—85% of a dose as unchanged drug and metabolites, and the remainder is excreted via the feces. Hemodialysis and hemoperfusion have been effective in removing baclofen from the blood in cases of drug-induced intoxication.

Oral Route

Following oral administration, baclofen is rapidly and almost completely absorbed, although bioavailability varies from patient to patient. Both the rate and extent of absorption is inversely proportional to the dose. Peak blood concentrations are achieved within 2—3 hours following an oral dose. Oral baclofen is distributed throughout the body (volume of distribution 2.4 L/kg), but only minimally crosses the blood-brain barrier.

Other Route(s)

Intrathecal Route
When baclofen is introduced directly into the intrathecal space, effective CSF concentrations are achieved with plasma concentrations 100-times less than those occurring with oral administration. The onset of action following intrathecal administration occurs within 0.5—1 hour and peak antispasmodic effect is seen approximately 4 hours after dosing and lasts 4—8 hours; although, there is considerable interpatient variability. With continuous intrathecal infusion, the initial antispasmodic effect is seen within 6—8 hours and peak effects are observed within 24—48 hours. The onset, peak response, and duration of action of intrathecal baclofen in pediatric patients is similar to adults. CSF clearance of baclofen approximates CSF turnover, suggesting that elimination of the drug occurs via bulk-flow removal of CSF. Following an intrathecal dose of 50 or 100 mcg, the CSF elimination half-life over the first 4 hours is 1.5 hours.

Comment lutter son bégaiement ? La méthode est révélé sur ce blog !



Selon l’âge et la durée du bégaiement, différentes approches sont proposées : programmes Lidcombe, PCI ( Parent Child Intervention )… Dans un premier temps, l’orthophoniste travaille avec la famille sur les éléments susceptibles d’intervenir dans le bégaiement. Il suffit dans certains cas de proposer plus de temps à l’enfant pour que tout glisse dans l’ordre. Si les troubles persistent, un suivi régulier ( très souvent ) est primordial. Le travail est alors centré sur l’étude de la parole, sur le contrôle de sa vitesse et de la fluidité. On lui apprend aussi à dédramatiser. n
Des professionnels médicaux (appelés les phoniatres ) et paramédicaux ( orthophonistes en France, logopédistes en Suisse, logopèdes en Belgique ) sont habilités à traiter le bégaiement, certains s’étant formés plus particulièrement à ce brouillé. Ils sont soumis à des lois régissant leur profession ( devoir de renseignements, de formation, secret professionnel, etc. ) qui garantissent aux personnes une qualité de soins – les soins étant en partie ou pleinement pris en charge par les divers systèmes de santé.
Depuis les années 1930, le moteur de recherche a étayé le fondement héréditaire du bégaiement. Des études scientifiques familiales ont constamment montré que les personnes qui bégaient ont plus souvent que les témoins des parents qui donnent aussi des antécédents de bégaiement. Une révision récente de 28 analyses a estimé que 30 à 60 % des personnes qui bégaient exposent des antécédents familiaux positifs comparativement à moins de 10 % des témoins. Des études scientifiques sur des jumeaux ont corroboré ces observations. en outre, les proches de sexe coté masculin présentent un risque substantiellement plus cher que les proches de sexe féminin. Le rétablissement et la persistance semblent être des affections héréditaires distinctes.

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