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Reservoir refilling must be performed by fully trained and qualified personnel following the directions provided by the pump manufacturerInadvertent injection into the subcutaneous tissue can occur if the reservoir refill septum is not properly accessedSubcutaneous injection may result in symptoms of a systemic overdose or early depletion of the reservoirRefill intervals should be carefully calculated to prevent depletion of the reservoiras this would result in the return of severe spasticity and possibly symptoms of withdrawal.
OverdoseSigns of overdose may appear suddenly or insidiouslyAcute massive overdose may present as comaLess sudden and/or less severe forms of overdose may present with signs of drowsinesslightheadednessdizzinesssomnolencerespiratory depressionseizuresrostral progression of hypotonia and loss of consciousness progressing to comaShould overdose appear likelythe patient should be taken immediately to a hospital for assessment and emptying of the pump reservoirIn cases reported to dateoverdose has generally been related to pump malfunctioninadvertent subcutaneous injectionor dosing errorSee Drug Overdose Symptoms and Treatment
One patienta 44 year-old male with MSdied in hospital on the second day following pump implantationAn autopsy demonstrated severe fibrosis of the coronary conduction systemA second patienta 52 year-old woman with MS and a history of an inferior wall myocardial infarctionwas found dead in bed 12 days after pump implantation2 hours after having had documented normal vital signsAn autopsy revealed pulmonary congestion and bilateral pleural effusionsIt is impossible to determine whether LIORESAL INTRATHECAL contributed to these deathsThe third patient underwent three baclofen screening trialsHis medical history included SCIaspiration pneumoniaseptic shockdisseminated intravascular coagulopathysevere metabolic acidosishepatic toxicityand status epilepticusTwelve days after screeninghe was not implantedhe again experienced status epilepticus with subsequent significant neurological deteriorationBased upon prior instructionextraordinary resuscitative measures were not pursued and the patient died.
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