Lioresal Intrathecal

Name: Lioresal Intrathecal

Before Using Lioresal

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

This medicine has been tested in children 4 years of age and older. Effective doses have not been shown to cause different side effects or problems in children than it does in adults. However, this medicine may not be safe for children younger than 4 years of age.

Geriatric

Side effects such as hallucinations, confusion or mental depression, other mood or mental changes, and severe drowsiness may be especially likely to occur in elderly patients, who may be more sensitive than younger adults to the effects of intrathecal baclofen.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alfentanil
  • Bromazepam
  • Buprenorphine
  • Butorphanol
  • Codeine
  • Dihydrocodeine
  • Donepezil
  • Doxylamine
  • Fentanyl
  • Flibanserin
  • Hydrocodone
  • Hydromorphone
  • Levorphanol
  • Meperidine
  • Methadone
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Oxycodone
  • Oxymorphone
  • Pentazocine
  • Periciazine
  • Remifentanil
  • Sodium Oxybate
  • Sufentanil
  • Tapentadol
  • Tramadol
  • Zolpidem

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Breathing difficulties or
  • Stroke or other brain disease—Baclofen may make these conditions worse
  • Communication difficulties or
  • Spinal cord injuries, at or above T–6 or
  • Withdrawal symptoms, history of—These conditions may increase your risk for side effects of baclofen
  • Epilepsy or
  • Kidney disease or
  • Mental or emotional problems or
  • Spinal lesions—The chance of side effects may be increased
  • Parkinson's disease—Baclofen may make this condition worse

Proper Use of baclofen

This section provides information on the proper use of a number of products that contain baclofen. It may not be specific to Lioresal. Please read with care.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Lioresal Intrathecal Dosage and Administration

Refer to the manufacturer's manual for the implantable pump approved for intrathecal infusion for specific instructions and precautions for programming the pump and/or refilling the reservoir. There are various pumps with varying reservoir volumes and there are various refill kits available. It is important to be familiar with all of these products in order to select the appropriate refill kit for the particular pump in use.

Screening Phase

Prior to pump implantation and initiation of chronic infusion of Lioresal Intrathecal (baclofen injection), patients must demonstrate a positive clinical response to a Lioresal Intrathecal bolus dose administered intrathecally in a screening trial. The screening trial employs Lioresal Intrathecal at a concentration of 50 mcg/mL. A 1 mL ampule (50 mcg/mL) is available for use in the screening trial. The screening procedure is as follows. An initial bolus containing 50 micrograms in a volume of 1 milliliter is administered into the intrathecal space by barbotage over a period of not less than one minute. The patient is observed over the ensuing 4 to 8 hours. A positive response consists of a significant decrease in muscle tone and/or frequency and/or severity of spasms. If the initial response is less than desired, a second bolus injection may be administered 24 hours after the first. The second screening bolus dose consists of 75 micrograms in 1.5 milliliters. Again, the patient should be observed for an interval of 4 to 8 hours. If the response is still inadequate, a final bolus screening dose of 100 micrograms in 2 milliliters may be administered 24 hours later.

Pediatric Patients

The starting screening dose for pediatric patients is the same as in adult patients, i.e., 50 mcg. However, for very small patients, a screening dose of 25 mcg may be tried first. Patients who do not respond to a 100 mcg intrathecal bolus should not be considered candidates for an implanted pump for chronic infusion.

Post-Implant Dose Titration Period

To determine the initial total daily dose of Lioresal Intrathecal following implant, the screening dose that gave a positive effect should be doubled and administered over a 24-hour period, unless the efficacy of the bolus dose was maintained for more than 8 hours, in which case the starting daily dose should be the screening dose delivered over a 24-hour period. No dose increases should be given in the first 24 hours (i.e., until the steady state is achieved).

Adult Patients with Spasticity of Spinal Cord Origin

After the first 24 hours, for adult patients, the daily dosage should be increased slowly by 10-30% increments and only once every 24 hours, until the desired clinical effect is achieved.

Adult Patients with Spasticity of Cerebral Origin

After the first 24 hours, the daily dose should be increased slowly by 5-15% only once every 24 hours, until the desired clinical effect is achieved.

Pediatric Patients

After the first 24 hours, the daily dose should be increased slowly by 5-15% only once every 24 hours, until the desired clinical effect is achieved. If there is not a substantive clinical response to increases in the daily dose, check for proper pump function and catheter patency. Patients must be monitored closely in a fully equipped and staffed environment during the screening phase and dose-titration period immediately following implant. Resuscitative equipment should be immediately available for use in case of life-threatening or intolerable side effects.

Maintenance Therapy

Spasticity of Spinal Cord Origin Patients

The clinical goal is to maintain muscle tone as close to normal as possible, and to minimize the frequency and severity of spasms to the extent possible, without inducing intolerable side effects. Very often, the maintenance dose needs to be adjusted during the first few months of therapy while patients adjust to changes in life style due to the alleviation of spasticity. During periodic refills of the pump, the daily dose may be increased by 10-40%, but no more than 40%, to maintain adequate symptom control. The daily dose may be reduced by 10-20% if patients experience side effects. Most patients require gradual increases in dose over time to maintain optimal response during chronic therapy. A sudden large requirement for dose escalation suggests a catheter complication (i.e., catheter kink or dislodgement).

Maintenance dosage for long term continuous infusion of Lioresal Intrathecal (baclofen injection) has ranged from 12 mcg/day to 2003 mcg/ day, with most patients adequately maintained on 300 micrograms to 800 micrograms per day. There is limited experience with daily doses greater than 1000 mcg/day. Determination of the optimal Lioresal Intrathecal dose requires individual titration. The lowest dose with an optimal response should be used.

Spasticity of Cerebral Origin Patients

The clinical goal is to maintain muscle tone as close to normal as possible and to minimize the frequency and severity of spasms to the extent possible, without inducing intolerable side effects, or to titrate the dose to the desired degree of muscle tone for optimal functions. Very often the maintenance dose needs to be adjusted during the first few months of therapy while patients adjust to changes in life style due to the alleviation of spasticity. During periodic refills of the pump, the daily dose may be increased by 5-20%, but no more than 20%, to maintain adequate symptom control. The daily dose may be reduced by 10-20% if patients experience side effects. Many patients require gradual increases in dose over time to maintain optimal response during chronic therapy. A sudden large requirement for dose escalation suggests a catheter complication (i.e., catheter kink or dislodgement).

Maintenance dosage for long term continuous infusion of Lioresal Intrathecal (baclofen injection) has ranged from 22 mcg/ day to 1400 mcg/ day, with most patients adequately maintained on 90 micrograms to 703 micrograms per day. In clinical trials, only 3 of 150 patients required daily doses greater than 1000 mcg/ day.

Pediatric Patients

Use same dosing recommendations for patients with spasticity of cerebral origin. Pediatric patients under 12 years seemed to require a lower daily dose in clinical trials. Average daily dose for patients under 12 years was 274 mcg/ day, with a range of 24 to 1199 mcg/ day. Dosage requirement for pediatric patients over 12 years does not seem to be different from that of adult patients. Determination of the optimal Lioresal Intrathecal dose requires individual titration. The lowest dose with an optimal response should be used.

Potential need for dose adjustments in chronic use

During long term treatment, approximately 5% (28/627) of patients become refractory to increasing doses. There is not sufficient experience to make firm recommendations for tolerance treatment; however, this "tolerance" has been treated on occasion, in hospital, by a "drug holiday" consisting of the gradual reduction of Lioresal Intrathecal over a 2 to 4 week period and switching to alternative methods of spasticity management. After the "drug holiday," Lioresal Intrathecal may be restarted at the initial continuous infusion dose.

Stability

Parenteral drug products should be inspected for particulate matter and discoloration prior to administration, whenever solution and container permit.

Delivery Specifications

The specific concentration that should be used depends upon the total daily dose required as well as the delivery rate of the pump. Lioresal Intrathecal may require dilution when used with certain implantable pumps. Please consult manufacturer's manual for specific recommendations.

Preparation Instruction

Screening

Use the 1 mL screening ampule only (50 mcg/mL) for bolus injection into the subarachnoid space. For a 50 mcg bolus dose, use 1 mL of the screening ampule. Use 1.5 mL of 50 mcg/mL baclofen injection for a 75 mcg bolus dose. For the maximum screening dose of 100 mcg, use 2 mL of 50 mcg/mL baclofen injection (2 screening ampules).

Maintenance

For patients who require concentrations other than 500 mcg/mL or 2000 mcg/mL, Lioresal Intrathecal must be diluted.

Lioresal Intrathecal must be diluted with sterile preservative free Sodium Chloride for Injection, U.S.P.

Delivery Regimen

Lioresal Intrathecal is most often administered in a continuous infusion mode immediately following implant. For those patients implanted with programmable pumps who have achieved relatively satisfactory control on continuous infusion, further benefit may be attained using more complex schedules of Lioresal Intrathecal delivery. For example, patients who have increased spasms at night may require a 20% increase in their hourly infusion rate. Changes in flow rate should be programmed to start two hours before the time of desired clinical effect.

PRINCIPAL DISPLAY PANEL - 10 mg/20 mL Outer Box Label

SAOL
NDC 70257-560-01

LIORESAL® INTRATHECAL
(baclofen injection) Refill Kit
For use with SynchroMed® Infusion Systems

8561

10 mg/20 mL
(500 mcg/mL)

CONTENTS:

  • Refill Instructions

Drug Box:

  • One 20-mL Lioresal Intrathecal
    Ampule
  • Drug prescribing information

Refill Kit*:

  • 20-mL syringe
  • Extension set with a clamp
  • Two 22-gauge noncoring needles
  • Template
  • 0.22-micron filter
  • Accessories

Drug Preparation Kit*:

  • 20-mL syringe
  • Filter Straw® tube
  • Accessories
  • Drug preparation instructions

TOTAL VOLUME: 20 mL (One 20-mL Ampule)

*The contents of these kits have been sterilized by ethylene oxide gas.

Do not use if the seals or packages
are damaged.
Does not require refrigeration.
Do not store above 86 °F (30 °C).
Do not freeze.
Do not heat sterilize.
The device has no components
made of natural rubber latex.

Lot No.: X000000000

Use By: 0000-00-00

NOTE: Individual kits within this
package may have a later use-by
date than the one listed above.

FPO BAR CODE

Rx only

Lioresal Intrathecal number of billing units: 1

Read and follow all enclosed instructions

Saol Therapeutics Inc.
Roswell, GA 30076

Side Effects

Drowsiness, dizziness, weakness, headache, constipation, nausea, or vomiting may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, depression, hallucinations), numb/tingling skin, vision changes, difficulty urinating.

Get medical help right away if you have any very serious side effects, including: seizures, trouble breathing.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

List Lioresal INTRATHECAL Ampul side effects by likelihood and severity.

Precautions

Before using baclofen, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: recent/current infection, seizures, mental/mood disorders (such as schizophrenia), kidney disease.

This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

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