Jamshidi Nazila, Morley Kirsten C, Cairns Rose, Dawson Andrew, Haber Paul S
Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia.
School of Medicine, NHMRC Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, NSW, Australia.
Alcohol Alcohol. 2019 Jan 1;54(1):73-78. doi: 10.1093/alcalc/agy082.
to describe trends in baclofen reports to Australia's largest Poisons Information Centre (PIC) and present a case series detailing severity of overdoses.
PBS data demonstrates baclofen use is increasing in Australia, while calls to NSWPIC illustrate an increase in number of exposures associated with toxicity. Baclofen toxicity may require prolonged intensive care admission. To minimize harms associated, especially with off-label baclofen prescribing for AUD, prescribers should pay careful attention to psychiatric comorbidities, and closely monitor treatment and dispensing.
this is a retrospective observational study of baclofen overdoses reported to New South Wales PIC (NSWPIC) from January 1 2004 to 31 December 2016. In addition, referrals to a metropolitan toxicology service relating to baclofen toxicity from 2014 to 2017 were analysed. The number of Pharmaceutical Benefit Scheme (PBS) claims for baclofen were also reviewed.
during the 13-year study period, 403 cases of baclofen toxicity were reported to NSWPIC. There was a 230% increase in annual exposures over this period, 71% of patients were symptomatic, with 77% requiring hospitalization. Coingestants were reported in 53%, with 57% being psychoactive medications (including alcohol). An increase in number of baclofen dispensing episodes was also noted. From the five cases of deliberate self-harm reported to the metropolitan toxicology service, three obtained baclofen for management of alcohol use disorder (AUD) and required prolonged treatment in the intensive care unit (ICU).
NSWPIC data shows an increase in number of calls regarding intentional baclofen exposures in parallel with increase the number of baclofen PBS claims. These closely parallel the increase in dispensing of baclofen since 2008. Case studies presented reinforce the severity of baclofen toxicity. Together, they demonstrate the potential risk of harm of baclofen prescribing, and the greater need for caution. Baclofen should be considered carefully in patients high risk of overdose or be used only in specialist services with close monitoring.
描述向澳大利亚最大的毒物信息中心（PIC）报告的巴氯芬相关情况的趋势，并呈现一系列详细说明过量用药严重程度的病例。
澳大利亚药品福利计划（PBS）数据表明巴氯芬在澳大利亚的使用量正在增加，而向新南威尔士州毒物信息中心（NSWPIC）的咨询电话显示与毒性相关的接触案例数量有所增加。巴氯芬中毒可能需要长时间入住重症监护病房。为尽量减少相关危害，尤其是非标签使用巴氯芬治疗酒精使用障碍（AUD）时，开处方者应密切关注精神科合并症，并密切监测治疗和配药情况。
这是一项对2004年1月1日至2016年12月31日期间向新南威尔士州毒物信息中心（NSWPIC）报告的巴氯芬过量用药情况的回顾性观察研究。此外，还分析了2014年至2017年期间转介至一家大都市毒理学服务机构的与巴氯芬毒性相关的病例。同时也审查了巴氯芬的药品福利计划（PBS）报销申请数量。
在为期13年的研究期间，NSWPIC共收到403例巴氯芬中毒报告。在此期间，每年的接触案例数量增加了230%，71%的患者出现症状，其中77%需要住院治疗。53%的案例报告了合并摄入其他物质的情况，其中57%为精神活性药物（包括酒精）。巴氯芬的配药次数也有所增加。在向大都市毒理学服务机构报告的5例蓄意自伤案例中，有3例获取巴氯芬用于治疗酒精使用障碍（AUD），并需要在重症监护病房（ICU）接受长时间治疗。
NSWPIC的数据显示，与巴氯芬的PBS报销申请数量增加同时，关于故意接触巴氯芬的咨询电话数量也在增加。这些情况与自2008年以来巴氯芬配药数量的增加密切平行。所呈现的案例研究强化了巴氯芬毒性的严重程度。综合来看，它们表明了巴氯芬处方存在潜在危害风险，以及更需谨慎的必要性。对于有过量用药高风险的患者，应谨慎考虑使用巴氯芬，或仅在密切监测的专科服务中使用。
