Considerations in the treatment of spasticity with intrathecal baclofen

Purpose. The etiology, diagnosis, and treatment of spasticity of cerebral and spinal origin are reviewed, with emphasis on treatment with intrathecal baclofen and the role of pharmacists in patient management. Summary. Spasticity is a motor symptom characterized by neurologic etiology and involuntary, velocity-dependent hypertonia. Its severity can vary, and its effects on activities of daily living and quality of life can be significant. Since the pathophysiology of spasticity is not fully understood and since it is associated with many underlying conditions, its treatment can be complex, often requiring a multidisciplinary approach involving physicians, therapists, nurses, and pharmacists. Setting achievable goals based on individual patient assessment and needs should drive therapy decisions. Baclofen injection concentrate for intrathecal administration has FDA-approved labeling for use in patients with severe spasticity who are intolerant or unresponsive to other therapies. Due to its intrathecal delivery, adverse effects are minimized, and patient response is enhanced. Pharmacists should remain knowledgeable about therapy management in patients receiving treatment for spasticity, including adverse event monitoring, infusion device complications, and dosage adjustments. If compounded intrathecal baclofen preparations are used, pharmacists should consider potency and sterility issues associated with high-risk level compounded sterile preparations and the potential for deviations in potency and sterility that may affect patient safety and outcomes. Conclusion. When managing spasticity symptoms, a comprehensive treatment plan as well as a multidisciplinary approach is required. Pharmacists should be well-versed in spasticity treatment, particular intrathecal therapies since close monitoring, dosage adjustment, concentration accuracy, and product sterility are necessary for optimal patient outcomes.