# Situation: A 30-year-old woman with relapsing-remitting multiple sclerosis (MS) comes to the neurology clinic. She was diagnosed 2 years ago and now takes interferon beta injections and oral baclofen for leg spasticity. She says baclofen makes her drowsy and she plans to stop taking it tomorrow. What should the nurse advise her?

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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 30-year-old woman with relapsing-remitting multiple sclerosis (MS) comes to the neurology clinic. She was diagnosed 2 years ago and now takes interferon beta injections and oral baclofen for leg spasticity.

She says baclofen makes her drowsy and she plans to stop taking it tomorrow. What should the nurse advise her?

## 보기

1. Take the whole day's dose at bedtime so she sleeps through it
2. Do not stop it suddenly; ask the provider about a lower dose **✔ 정답**
3. Stop it for 2 days and restart it once the drowsiness wears off
4. Stop it tomorrow, since drowsiness means the dose is too high

**정답: 2**

## 해설

Drowsiness is a common adverse effect of baclofen, but stopping it abruptly can cause withdrawal with seizures, hallucinations, high fever, and rebound spasticity. The dose is changed or tapered only by the provider. Changing the timing or taking a break on her own carries the same risks.

## 심화 해설

Why abrupt baclofen discontinuation is dangerous

Baclofen is a gamma-aminobutyric acid type B (GABA-B) receptor agonist that suppresses excitatory neurotransmission in the spinal cord and brain. With regular use, the central nervous system adapts to the drug’s inhibitory tone. When the drug is removed suddenly, that inhibitory brake disappears, and the nervous system rebounds into a hyperexcitable state [1].

Abrupt withdrawal can trigger seizures, hallucinations, high fever, severe rebound spasticity, and autonomic instability. These symptoms are not merely uncomfortable; they can progress to life-threatening toxicity or withdrawal syndrome [1]. Even a relatively short interruption matters. In one multiple sclerosis patient, a 10-hour perioperative pause in oral baclofen produced severe rebound spasticity of the leg muscles [3].

Watch out! Withdrawal is not limited to intrathecal baclofen. Oral baclofen carries the same risk when stopped abruptly [1][2].

Why drowsiness does not justify self-discontinuation

Sedation is a well-known, dose-related adverse effect of baclofen. It reflects the drug’s GABA-B agonist activity in the central nervous system, not necessarily a toxic or dangerous level. The appropriate response is dose adjustment under supervision, not abrupt cessation [1].

The dose is changed or tapered only by the provider. The patient should be advised to contact the neurology provider to discuss a lower dose or alternative spasticity management rather than stopping the medication on her own [1].

Why the other options are unsafe

| Option | Why it is incorrect |
| --- | --- |
| 1. Take the whole day’s dose at bedtime | Changing the timing or consolidating doses alters drug levels and does not eliminate withdrawal risk. It also does not address the underlying need for dose adjustment. |
| 3. Stop for 2 days and restart | Even brief interruption can precipitate rebound spasticity and withdrawal symptoms [3]. A self-directed drug holiday is unsafe. |
| 4. Stop tomorrow because drowsiness means the dose is too high | Drowsiness is a common adverse effect, not proof of toxicity. Abrupt discontinuation risks withdrawal, which can be more dangerous than the sedation itself [1]. |

Clinical correlation for nursing practice

Baclofen withdrawal can present with unusual symptoms. A case report described severe hyperalgesia-like pain disproportionate to expected postoperative recovery in a patient whose oral baclofen was interrupted [2]. Another report documented cardiac arrest as a rare complication of baclofen withdrawal after intrathecal pump removal . These examples reinforce that withdrawal is unpredictable and potentially catastrophic.

Key point! When a patient reports intolerable baclofen side effects, the nurse’s priority is to prevent abrupt withdrawal by facilitating prompt communication with the prescribing provider for a supervised taper or alternative therapy [1].References (research sources)

- [1]Baclofen therapeutics, toxicity, and withdrawal: A narrative review.Research articleRomito JW, Turner ER, Rosener JA, Coldiron L, Udipi A, Nohrn L (2021) · DOI: 10.1177/20503121211022197

- [2]Lost in Transition: A Case Study of Oral Baclofen Withdrawal Presenting as Severe Pain.Case reportLaCroix K, Patel P, Selod O. (2026) · DOI: 10.7759/cureus.112805

- [3]Intrathecal Baclofen Injection to Avoid Withdrawal in a Multiple Sclerosis Patient Undergoing Lumbar Spine Surgery: A Case Report.Case reportDupanovic M, Devine RP, Jackson SR, Lynch SG (2018) · DOI: 10.1213/XAA.0000000000000668

## 임상 시나리오

Baclofen Withdrawal PreventionSafe management of drowsiness in MS patients
Drowsiness is a common dose-related effect of baclofen, not a sign of toxicity. The correct response is provider-guided dose reduction or taper, never sudden self-discontinuation.

Abrupt baclofen withdrawal can cause seizures, hallucinations, high fever, autonomic instability, and rebound spasticity. Even short interruptions, such as 10 hours, may trigger severe symptoms.

CautionOral baclofen carries the same withdrawal risk as intrathecal baclofen. Advise the patient to contact the neurology provider before changing the dose, timing, or stopping the medication.

## 핵심 개념

- **Baclofen** — A GABA-B agonist used to reduce spasticity; abrupt discontinuation can cause withdrawal including seizures, hallucinations, and rebound spasticity.
- **GABA-B receptor** — A central nervous system receptor that mediates inhibitory neurotransmission; chronic baclofen use leads to adaptation that makes sudden removal dangerous.
- **Rebound spasticity** — Worsening of muscle spasticity that occurs when a spasmolytic drug is stopped too quickly.
- **Withdrawal syndrome** — A set of symptoms such as seizures, high fever, and autonomic instability caused by abrupt removal of a drug after dependence develops.

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