title: Baclofen overdose treated with continuous venovenous hemofiltration.
abstract: OBJECTIVE
  Overdose with baclofen, a derivative of the inhibitory neurotransmitter γ-aminobutyric acid, may lead to severe respiratory and central nervous system depression and can be life-threatening. Prolonged half-lives of baclofen, of up to 34 h, have been reported in patients after overdose. Hemodialysis has proven to be a successful approach to improve clearance of baclofen, but the value of continuous venovenous hemofiltration (CVVH) is unclear. We applied CVVH in a patient with acute baclofen overdose.
  
  
  METHODS
  Pharmacokinetic measurements of baclofen in serum and hemofiltrate were made at six time points after hospital admission. Baclofen concentration-time data were analyzed using non-compartmental methods, and the relative contribution of clearance by hemofiltration to total baclofen clearance was calculated.
  
  
  RESULTS
  Baclofen concentrations in serum varied between 1.81 and 0.05 mg/L. Concentrations of baclofen in hemofiltrate were within the same range (between 0.74 and 0.05 mg/L), and the elimination half-life during hemofiltration was estimated at 4.8 h. Total clearance and clearance via hemofiltration were estimated at 6.6 and 2.4 L/h, indicating that clearance could be increased by approximately 57 % by applying hemofiltration.
  
  
  CONCLUSIONS
  The presented case demonstrates the usefulness of CVVH in the treatment of baclofen overdose and indicates that CVVH can be used as an alternative to hemodialysis in patients with overdose of baclofen.
authors.affiliation: Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Didier
authors.initials: D
authors.lastname: Meulendijks
authors.forename: Saheed
authors.initials: S
authors.lastname: Khan
authors.forename: Cornelis H W
authors.initials: CH
authors.lastname: Koks
authors.forename: Alwin D R
authors.initials: AD
authors.lastname: Huitema
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Schellens
authors.forename: Jos H
authors.initials: JH
authors.lastname: Beijnen
mesh_terms: D001418:Baclofen / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning; D062787:Drug Overdose / Q000601:surgery*; D006440:Hemofiltration; D006801:Humans; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen