Overdose : מינון יתר

4.9 Overdose
Special attention should be given to recognising the signs and symptoms of overdosage at all times, but especially during the initial "screening" and "dose-titration" phases and also during reintroduction of Baclofen Sintetica after an interruption of therapy.

Signs of overdose may appear suddenly or (more usually) insidiously.
Symptoms of overdose: excessive muscular hypotonia, drowsiness, light-headedness, dizziness, somnolence, seizures, loss of consciousness, hypothermia, excessive salivation, nausea, vomiting, tachycardia and tinnitus.

Respiratory depression, apnoea, and coma result from serious overdosage. Seizures may occur with increasing dosage or, more commonly, during recovery from an overdose. Serious overdose may occur through the inadvertent delivery of the catheter contents, errors in pump programming, excessively rapid dose increases or concomitant treatment with oral baclofen. Possible pump malfunction should also be investigated.

Treatment
There is no specific antidote for treating overdoses of intrathecal baclofen. Any instructions provided by the pump manufacturer should be followed, and the following steps should generally be undertaken:
• Where a programmable continuous infusion pump is used further delivery of baclofen should be halted immediately by removal of residual drug solution from the reservoir.
• If it is possible to do so without surgical intervention the intrathecal catheter should be disconnected from the pump as soon as possible, and infusion fluid allowed to drain back together with some CSF (up to 30-40 ml is suggested).
• Patients with respiratory depression should be intubated if necessary and ventilated artificially if required. Cardiovascular functions should be supported and in the event of convulsions, iv diazepam cautiously administered.
• Blood pressure, pulse, body temperature, cardiac rhythm and respiratory rate should be monitored.