Baclofen in Central Fever Management

Critical Safety Considerations

• The American Academy of Neurology and Mayo Clinic experts warn that abrupt discontinuation of baclofen is potentially catastrophic and must be avoided, as it can lead to baclofen withdrawal syndrome, which manifests with high fever, altered mental status, hallucinations, delirium, seizures, tachycardia, rebound spasticity, and muscle rigidity 1, 2
• The Mayo Clinic Proceedings guidelines emphasize that intrathecal baclofen withdrawal is life-threatening, leading to rhabdomyolysis, multiorgan failure, and death, and that withdrawal typically evolves over 1-3 days but may become fulminant if not recognized 1, 2, 3, 4
• The Anaesthesia journal recommends that even oral baclofen withdrawal can cause severe symptoms, including fever, which could be confused with recurrent central fever, highlighting the need for careful management and monitoring 3, 4

Common Pitfalls

• The Mayo Clinic Proceedings advises against abruptly discontinuing baclofen once initiated, as withdrawal fever may be mistaken for treatment failure, and recommends continuing baclofen perioperatively in patients already receiving it to prevent withdrawal syndrome 1, 2