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Letter
Baclofen at the end of life
  1. Rachel Lindsay Lee,
  2. Tammy Koay and
  3. Mary Miller
  1. Palliative Care Department, Oxford University Hospitals NHS Trust, Oxford, UK
  1. Correspondence to Rachel Lindsay Lee, Palliative Care Department, Oxford University Hospitals NHS Trust, Oxford, UK; Rachel.lee2{at}ouh.nhs.uk

https://doi.org/10.1136/spcare-2022-003889

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    Introduction

    Baclofen is a gamma-aminobutyric acid (GABA) derivative, exerting an antagonistic effect at GABAB-receptors. It is a smooth muscle relaxant, used in the management of spasticity. Sudden cessation of baclofen has been reported to cause a withdrawal syndrome characterised by hypertension, tachycardia, rebound spasticity, myoclonus, dystonia and pyrexia.1 Baclofen withdrawal syndrome (BWS) is both distressing and potentially fatal.2 The majority of reported cases of BWS result from malfunction of intrathecal pumps. BWS has been reported following abrupt cessation of oral baclofen.3

    There is little published evidence to guide the prevention or management of BWS at the end of life. Dying patients have an unreliable oral route. This composite case report describes the management of BWS in an actively dying 68-year-old man with multiple sclerosis.

    Case presentation

    The patient was admitted acutely for inpatient hospital management of a community-acquired pneumonia. Prior to admission, the patient was nursed in bed and had been living …

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    Footnotes

    • Twitter @dr_mary_miller

    • Contributors RLL undertook the literature review and wrote the article with MM. TK reviewed the pharmaceutical resources and reviewed the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.