Article

Baclofen-Induced Manic Symptoms: Case Report And Systematic Review

Psychosomatics (Impact Factor: 1.67). 02/2014; DOI: 10.1016/j.psym.2014.02.003

ABSTRACT Introduction
The gamma amino-butyric acid type-B (GABA-B) receptor agonist baclofen is approved for spasticity and is used off-label for diverse types of addictive disorders, notably alcohol dependence. Baclofen may induce numerous neuropsychiatric adverse drug reactions (ADRs), including behavioural disinhibition. However, this precise ADR has never been assessed using either a validated causality algorithm or a scale for manic symptoms.

Methods
We report the case of a 49-year-old male patient who exhibited de novo mania during treatment with baclofen for alcohol dependence. Symptoms were evaluated using the Young mania rating scale (YMRS), and the causality of baclofen was determined using Naranjo’s algorithm. This case was also compared with other cases of baclofen-induced mania through a systematic literature review.

Results
The patient, at 180 mg/d, presented with mania and scored 24/44 on the YMRS, and the imputability of baclofen was ‘probable’ using Naranjo’s algorithm (8/13). Four other cases of baclofen-induced mania were reported in the literature. Three cases had a bipolar I disorder history. Baclofen-induced manic symptoms (BIMSs) occurred mostly during the dose-escalation phase.

Conclusion
BIMSs may appear in patients with or without bipolar disorder. Particular attention is required during the dose-increase phase and in patients with a prior history of mood disorders.

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    ABSTRACT: Background Community pharmacists' liability is involved when they dispense off-label prescriptions (OLPs). However, their attitudes to off-label prescribing are little known, while in France off-label baclofen use for alcohol dependence is increasing. Objective To determine community pharmacists' attitudes to off-label prescribing of baclofen. Method A postal questionnaire was sent to 219 community pharmacies in the Nord-Pas-de-Calais region, France, previously identified as delivering at least five boxes of oral baclofen monthly. The questionnaire examined whether pharmacists delivered baclofen for alcohol dependence, how pharmacists detected off-label prescribing of baclofen, who were the most frequent prescribers (general practitioners or specialists), and pharmacists' attitudes to OLPs. Results Eighty pharmacies responded (36.5 %). Detection criteria for OLPs were supra-threshold dose (77.3 %) and "off-label" written on prescription (52.5 %). General practitioners were the most frequent prescribers of off-label baclofen. Pharmacists were more likely to refuse to fill prescriptions not marked "off-label" (6.0 %) than correctly marked prescriptions (1.5 %). 85 % of respondents considered they lacked information on off-label use. Conclusion Although community pharmacists felt they were poorly informed on off-label baclofen, the majority nevertheless delivered the drug. Since our survey, off-label baclofen prescribing has been strictly controlled in France. Pharmacists' current attitudes will need further evaluation.
    International Journal of Clinical Pharmacy 02/2015; 37(2). DOI:10.1007/s11096-015-0074-7 · 1.25 Impact Factor

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May 23, 2014