Special Senses: Abnormality of accommodation. In mothers treated with oral baclofen baclofen USP in therapeutic doses, the active substance passes into the breast milk. It is not known whether detectable levels of drug are present in breast milk of nursing mothers receiving intrathecal baclofen. As a general rule, nursing should be undertaken while a patient is receiving intrathecal baclofen only if the potential benefit justifies the potential risks to the infant. T-6 or above, communication difficulties, history of withdrawal symptoms from oral or intrathecal baclofen. Refer to the Indications, Drug Stability, and Emergency Procedures reference manual for indications and related information.
An occupational therapist may recommend different tools, like splints, casts, or braces, to keep up your range of motion and flexibility. But a variety of treatments, including medications, can help. Which therapies you use depends on the extent and severity of your spasticity. You may need more than one type to manage the problem. And for best results during stroke rehab, medications in combination with therapy such as and strengthening exercises work best and are typically the first line of treatment. Without daily physical rehab, the muscles will remain contracted and joints become immobile.
Multiple Sclerosis International Federation: "World of MS - Resources - Clinically isolated syndrome. 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.
For a 50 mcg bolus dose, use 1 mL of the screening ampule. What differentiates alcohol abuse from alcoholism? See your health care provider regularly for proper care of any medical or mental problems.
Determine the refill date from the printout, and schedule a refill appointment. This medicine may cause your blood sugar levels to rise. If you notice a change in the results of your blood or urine sugar test or if you have any questions about this, check with your doctor. Lamictal and other seizure medications can also become less effective when a woman is pregnant. Bouchard, Dorval, Quebec, H9S 1A9. Driving and using machines. Does the condition keep you from doing everyday tasks? Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets. Increase in blood sugar. Just picked this up for my mother after calling in refill for Flexeril. Insurance company mandate because she is considered a fall risk at 84. I read thru the site here because I trust no one from long experience. She will never take this stuff! If overdose is suspected, patient should be evaluated immediately in a hospital setting and the pump reservoir emptied. Lioresal Intrathecal baclofen injection in pre- and post-marketing studies evaluated as of December 1992. Because these patients were treated under uncontrolled clinical settings, it is impossible to determine definitively what role, if any, Lioresal Intrathecal played in their deaths. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.
LIORESAL. Ovarian cysts have been found by palpation in about 4% of the multiple sclerosis patients who were treated with oral LIORESAL for up to one year. In most cases these cysts disappeared spontaneously while patients continued to receive the drug. Ovarian cysts are estimated to occur spontaneously in approximately 1% to 5% of the normal female population. If you are using this drug on a regular schedule and miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Should overdose appear likely, the patient should be taken immediately to a hospital for assessment and emptying of the pump reservoir. In cases reported to date, overdose has generally been related to pump malfunction, inadvertent subcutaneous injection, or dosing error. See Drug Overdose Symptoms and Treatment. The more common 1% or more adverse events reported in the prospectively followed 211 patients exposed to Lioresal Intrathecal baclofen injection have been reported. The pump system should not be implanted until the patient's response to bolus Baclofen Injection Intrathecal is adequately evaluated. Evaluation consisting of a screening procedure: see Dosage and Administration requires that Baclofen Injection Intrathecal be administered into the intrathecal space via a catheter or lumbar puncture. Because of the risks associated with the screening procedure and the adjustment of dosage following pump implantation, these phases must be conducted in a medically supervised and adequately equipped environment following the instructions outlined in the Dosage and Administration section. Teva Pharmaceuticals USA. Baclofen tablets, USP prescribing information. Sellersville, PA; 2010 May. From DailyMed website. Spasticity of Cerebral Origin: The efficacy of Lioresal Intrathecal was investigated in three controlled clinical trials; two enrolled patients with cerebral palsy and one enrolled patients with spasticity due to previous brain injury. The first study, a randomized controlled cross-over trial of 51 patients with cerebral palsy, provided strong, statistically significant results; Lioresal Intrathecal was superior to placebo in reducing spasticity as measured by the Ashworth Scale. A second cross-over study was conducted in 11 patients with spasticity arising from brain injury. Adverse events associated with the use of Lioresal Intrathecal reflect experience gained with 576 patients followed prospectively in the United States. Abrupt discontinuation of intrathecal baclofen, regardless of the cause, has resulted in sequelae that include high fever, altered mental status, exaggerated rebound spasticity, and muscle rigidity, that in rare cases has advanced to rhabdomyolysis, multiple organ-system failure and death. Precautions in special patient populations: Careful dose titration of Lioresal Intrathecal is needed when spasticity is necessary to sustain upright posture and balance in locomotion or whenever spasticity is used to obtain optimal function and care. If you have any questions about Lioresal, please talk with your doctor, pharmacist, or other health care provider. LIORESAL INTRATHECAL baclofen injection is indicated for use in the management of severe spasticity. Patients should first respond to a screening dose of intrathecal baclofen prior to consideration for long term infusion via an implantable pump. For spasticity of spinal cord origin, chronic infusion of LIORESAL INTRATHECAL via an implantable pump should be reserved for patients unresponsive to oral baclofen therapy, or those who experience intolerable CNS side effects at effective doses. Patients with spasticity due to traumatic brain injury should wait at least one year after the injury before consideration of long term intrathecal baclofen therapy. LIORESAL INTRATHECAL is intended for use by the intrathecal route in single bolus test doses via spinal catheter or lumbar puncture and, for chronic use, only in implantable pumps approved by the FDA specifically for the administration of LIORESAL INTRATHECAL into the intrathecal space. Is your spasticity limited to only one arm? There is inadequate systematic experience with the use of LIORESAL INTRATHECAL in combination with other medications to predict specific drug-drug interactions. Interactions attributed to the combined use of LIORESAL INTRATHECAL and epidural morphine include hypotension and dyspnea. You should not use Botox if you have an infection in the area where the medicine will be injected. Botox should not be used to treat overactive bladder or incontinence if you have a current bladder infection or if you are unable to urinate unless you routinely use a catheter. All patients receiving intrathecal baclofen therapy are potentially at risk for withdrawal. Early symptoms of baclofen withdrawal may include return of baseline spasticity, pruritus, hypotension, and paresthesias. Priapism may develop or recur if treatment with intrathecal baclofen is interrupted. Some clinical characteristics of the advanced intrathecal baclofen withdrawal syndrome may resemble autonomic dysreflexia, infection sepsis malignant hyperthermia, neuroleptic-malignant syndrome, or other conditions associated with a hypermetabolic state or widespread rhabdomyolysis. clarithromycin
Medtronic Inc. Lioresal baclofen intrathecal injection SynchroMed infusion pump product monograph. For information on systemic interactions resulting from concomitant use, see Interactions. This is what happens when corporations own our government! Overdose generally related to pump malfunction or dosing error. Intrathecal management of severe spasticity of spinal cord origin in patients who do not tolerate or respond adequately to oral baclofen; 109 110 113 114 115 116 117 118 119 120 considered an alternative to destructive neurosurgical procedures. 113 Also, intrathecal management of intractable spasticity secondary to severe chronic disorders such as multiple sclerosis and other types of spinal diseases such as spinal ischemia, spinal tumor, transverse myelitis, cervical spondylosis, and degenerative myelopathy; designated an orphan drug by FDA for use in these conditions. bimatoprost to use bimatoprost
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. The Product must be used in accordance with the labeling and instructions for use provided with the Product. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. Multiple Sclerosis: Designing an Exercise Program. Use the appropriate Medtronic refill kit during all refill procedures for Medtronic implantable infusion pumps. Using components other than Medtronic components or a kit other than the appropriate refill kit can damage Medtronic components, requiring surgical revision or replacement, and allow drug leakage into surrounding tissue, resulting in loss of or change in therapy, which may lead to a return of underlying symptoms, drug withdrawal symptoms, or a clinically significant or fatal drug underdose or overdose. The Multiple Sclerosis Study Group. Annals of Neurology, 1990. PLMD movements are not myoclonus, however, and the original name is not used today. Do you have epilepsy? Duncan GW, Shahani BT, Young RR. An evaluation of baclofen treatment for certain symptoms in patients with spinal cord lesions. Neurology. 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. See the pump programmer for the expected volume. The amount withdrawn should approximately equal the expected volume. Some of these side effects may decrease after you have been using this for a while. If any of these effects persist or worsen, tell your doctor or promptly. ALS, is a disease that attacks the nerve cells in your and spinal cord. There is no known cure. Often, extra pressure around your belly ramps up acid reflux. Commonly Observed: In pre-marketing clinical trials, the most commonly observed adverse events associated with use of intrathecal baclofen which were not seen at an equivalent incidence among placebo-treated patients included: agitation, constipation, somnolence, leukocytosis, chills, urinary retention and hypotonia. Antiseizure, or anticonvulsant, drugs. Gabapentin Neurontin topiramate Topamax and valproic acid Depakote are commonly prescribed.
This must be performed in a hospital unit. Are you taking other medicines? Put blocks under the legs at the head of your bed to raise it at least 4 to 6 inches. This helps keep your stomach's contents down. Rebecca Gottesman, MD, PhD, Gottesman is assistant professor of cerebrovascular neurology at Johns Hopkins Hospital in Baltimore. Body as a Whole: Suicide, lack of drug effect, abdominal pain, hypothermia, neck rigidity, chest pain, chills, face edema, flu syndrome and overdose. This can sometimes be due to procedures such as a lumbar puncture, or "spinal tap. cheap condyline purchase visa otc condyline
This can help you find ways to dress, bathe, and groom. If you are not sure, ask your doctor or pharmacist. In the most severe cases of MS that don't respond to medication, doctors may prescribe mitoxantrone Novantrone or alemtuzumab Lemtrada. Both are chemotherapy drugs designed to treat cancer. They are used to treat certain types of MS by curbing the immune system to prevent it from attacking nerve coverings. 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. For oral baclofen, drowsiness, dizziness, weakness, fatigue. LIORESAL Intrathecal listed below. After confirming that the needle remains in the reservoir, resume injecting fluid. Hemic and Lymphatic System: Anemia. Hypersensitivity to baclofen. Lioresal Intrathecal is not recommended for intravenous, intramuscular, subcutaneous or epidural administration. Warning: If it is suspected or known that all or part of the drug was inadvertently injected into the pocket or the catheter access port during the refill procedure, monitor the patient closely for signs and symptoms of overdose in an appropriate facility for a sufficient amount of time or until the symptoms have resolved. Refer to the kit manual or the Indications, Drug Stability, and Emergency Procedures for SynchroMed and IsoMed Infusion Systems Reference Manual for emergency procedures associated with drug underdose and overdose. Refer to the drug product information label for specific drug underdose and overdose symptoms and methods of management. Rae-Grant, A. D. Multiple Sclerosis, 1999. Confirm that the volume of the prescribed fluid does not exceed the reservoir volume of the pump. Importance of informing patients of other important precautionary information. See Cautions. Muscle relaxant drugs. These drugs relax tense muscles and include baclofen Lioresal and tizanidine Zanaflex. The information contained in the Truven Health Micromedex products as delivered by Drugs. Steroids won't slow down the course of your overall disease, though. cheap aggrenox pills for sale
Use and dose must be determined by your doctor. This Limited Warranty is made only to the purchaser who uses the Product. AS TO ALL OTHERS, MEDTRONIC MAKES NO WARRANTY, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WHETHER ARISING FROM STATUTE, COMMON LAW, CUSTOM OR OTHERWISE. NO EXPRESS OR IMPLIED WARRANTY TO THE PATIENT SHALL EXTEND BEYOND THE PERIOD SPECIFIED IN A1 ABOVE. THIS LIMITED WARRANTY SHALL BE THE EXCLUSIVE REMEDY AVAILABLE TO ANY PERSON. Figure 5. Open the clamp and inject into the pump reservoir. CSF by lumbar puncture or through the catheter access port to reduce the concentration of baclofen in the CSF. Lioresal Intrathecal injection is adequately evaluated. Evaluation consisting of a screening procedure: see Dosage and Administration requires that Lioresal Intrathecal be administered into the intrathecal space via a catheter or lumbar puncture. Because of the risks associated with the screening procedure and the adjustment of dosage following pump implantation, these phases must be conducted in a medically supervised and adequately equipped environment following the instructions outlined in the section.
Caution: If you encounter unusual resistance before the maximum reservoir volume is injected or you are unable to inject fluid, the reservoir valve may have been activated. Activation of the pump reservoir valve seals the pump reservoir valve closed. If the valve closes, a portion of the reservoir contents must be delivered or removed before filling can be completed, and procedural delays can occur. Intrathecal baclofen therapy is valuable but hazardous. The 1970s are right here with us, and they're wondering, too. There are no adequate and well-controlled studies in pregnant women. In animal studies, baclofen had adverse effects on embryofetal development when administered orally to pregnant rats. LIORESAL INTRATHECAL should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Intrathecal management of severe spasticity of cerebral origin, including cerebral palsy and acquired brain injury; 113 121 122 123 124 125 126 127 considered an alternative to destructive neurosurgical procedures. 113 Designated an orphan drug by FDA for management of spasticity in patients with cerebral palsy. shop keftab manufacturer
Call your doctor if your muscle symptoms do not improve, or if they get worse. This is not a complete list of side effects. 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. Failure to recognize these signs and symptoms and to seek appropriate medical intervention can result in serious patient injury or death. Connect the needle to the extension set. Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. The following adverse events have been reported during post-approval use of Lioresal Intrathecal. Because these events are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency. Crosses the placenta b and distributes into milk following oral administration. This information should not be used to decide whether or not to take metaxalone or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about metaxalone. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to metaxalone. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using metaxalone. Prior to pump implantation and initiation of chronic infusion of Baclofen Injection Intrathecal patients must demonstrate a positive clinical response to a Baclofen Injection Intrathecal bolus dose administered intrathecally in a screening trial. Notify patient's physician managing intrathecal baclofen injection therapy. If the syringe maximum capacity is reached before the reservoir is completely empty, more than one syringe will be needed to empty the pump. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs including any herbal medicines or supplements or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. Nystagmus off-label use: Oral: 5 mg 3 times daily; may increase at weekly intervals until optimal response is reached or intolerable adverse effects occur. Dosage range studied: 15 to 120 mg daily in divided doses Cormer 2006; Dieterich 1991. Additional data may be necessary to further define the role of baclofen in the treatment of this condition. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. It is not known whether this drug passes into milk. Consult your doctor before -feeding. osir.info pantozol
Cohen. Neurology, Feb 10, 2009. F310411 - Leaflet LIORESAL 0 1 300ML UKv2. This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in that case. Since Botox has a temporary effect and is given at widely spaced intervals, missing a dose is not likely to be harmful. What happens if I overdose? WebMD User Reviews should not be considered as medical advice and are not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences may be a helpful health information resource but they are never a substitute for professional medical advice from a qualified healthcare provider. Baclofen given orally increased the incidence of fetal structural abnormalities omphaloceles in rats. Reductions in food intake and body weight gain were observed in the dams. No dose increases should be administered in the first 24 hours. Patients suffering from psychotic disorders, schizophrenia, or confusional states should be treated cautiously with Lioresal Intrathecal and kept under careful surveillance, because exacerbations of these conditions have been observed with oral administration. Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. This Limited Warranty is limited to its express terms. Refer to the appropriate information for prescribers booklet for contraindications, warnings, precautions, adverse events summary, individualization of treatment, patient selection, use in specific populations, and component disposal. LIORESAL INTRATHECAL caused their deaths. Two patients, however, did suffer sudden and unexpected death within 2 weeks of pump implantation and one patient died unexpectedly after screening. This drug is to be given continuously as an infusion. If your infusion is interrupted, contact your doctor or right away. Pruritus without rash, hypotension, paresthesia, fever, and altered mental state. Priapism may develop or recur if treatment with intrathecal baclofen is interrupted. Medtronic, Inc, Boston, MA: Personal communication.
Annals of Neurology, 1995. Each 20 mL ampoule contains 10 mg baclofen for intrathecal administration. Note: The model and reservoir volume can be confirmed by the programmer. Alternatively, a radiopaque identifier in the pump shows the pump model and identifies Medtronic as the pump manufacturer on a standard x-ray Figure 1. A three-letter code designates the pump model. LIORESAL pass into the breast milk. 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. Do not suddenly stop using Lioresal. Your doctor can tell you the best way to slowly reduce the dose. Note: Oral baclofen should not be relied upon as the sole treatment for intrathecal baclofen injection withdrawal syndrome. PLMD is more common in middle-aged and older people. Abrupt discontinuance of oral baclofen may result in hallucinations and seizures. Baclofen Injection Intrathecal is indicated for use in the management of severe spasticity. Patients should first respond to a screening dose of intrathecal baclofen prior to consideration for long term infusion via an implantable pump. For spasticity of spinal cord origin, chronic infusion of Baclofen Injection Intrathecal via an implantable pump should be reserved for patients unresponsive to oral baclofen therapy, or those who experience intolerable CNS side effects at effective doses. Patients with spasticity due to traumatic brain injury should wait at least one year after the injury before consideration of long term intrathecal baclofen therapy. Baclofen Injection Intrathecal is intended for use by the intrathecal route in single bolus test doses via spinal catheter or lumbar puncture and, for chronic use, only in implantable pumps approved by the FDA specifically for the administration of Baclofen Injection Intrathecal into the intrathecal space. Tricyclic antidepressants. These are older antidepressant drugs that include amitriptyline Elavil doxepin Silenor, Sinequan nortriptyline Pamelor and protriptlyne Vivactil. Worsening of the symptoms of has also been reported. Ampoules should not be either frozen or autoclaved. Store at room temperature away from light and moisture. not store in the bathroom. Keep all away from children and pets. Baclofen is a muscle-relaxant drug. cost of citalopram in the uk
Munger, K. Neurology, Jan 13, 2004. If your symptoms do not improve or if they become worse, check with your doctor. Do not seek botulinum toxin injections from more than one medical professional at a time. If you switch healthcare providers, be sure to tell your new provider how long it has been since your last botulinum toxin injection. Obama: 'If I had a son. Patients should be infection-free prior to the screening trial with LIORESAL INTRATHECAL baclofen injection because the presence of a systemic infection may interfere with an assessment of the patient's response to bolus LIORESAL INTRATHECAL. Lioresal may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Lioresal with caution. Sometimes the overuse of analgesic medicines causes a condition called medication overuse headache, or rebound headache. If you have NDPH, your doctor may suggest limiting the amount of analgesics, as too much may cause your head pain to worsen. Mutagenicity assays with baclofen have not been performed. Thank God her doctor is willing to go thru the prior authorization circus for Flexeril--she only uses it for occasional back spasms can't take Advil or Aleve. I feel sorry for people who don't have a dr to go the distance, or someone to advocate for them. Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? If you are using this medication on a regular schedule, you can get the most benefit from it by not missing any doses. To help you remember, use it at the same times each day. Continue using it for the full time prescribed. Latash ML, Penn RD, Corcos DM et al. Short-term effects of intrathecal baclofen in spasticity. Exp Neurol. Tolerance may develop during chronic intrathecal baclofen therapy. 113 115 No firm recommendations regarding amelioration of tolerance; patients occasionally have been hospitalized and intrathecal baclofen dosage decreased gradually over 2- to 4-week period, during which baclofen was alternated with other methods of spasticity management. 113 115 Sensitivity to baclofen may return after a few days, and continuous intrathecal baclofen therapy may be resumed at the previously effective initial dosage. clopidogrel
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Inadvertent injection into the catheter access port may result in a clinically significant or fatal drug overdose. If it is suspected or known that all or part of the drug was injected into the catheter access port during the refill procedure, monitor the patient closely for signs and symptoms of overdose in an appropriate facility for a sufficient amount of time or until the symptoms have resolved. Refer to the catheter access port kit manual or the Indications, Drug Stability, and Emergency Procedures for SynchroMed and IsoMed Implantable Infusion Systems Reference Manual for emergency procedures associated with drug overdose. Refer to the drug labeling for specific drug overdose symptoms and methods of management.
Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? It's a condition where you can't control your movements. What Causes Nystagmus? The usual screening bolus dose administered prior to pump implantation in these studies was typically 50 mcg. The maintenance dose ranged from 12 mcg to 2003 mcg per day. Because of the open, uncontrolled nature of the experience, a causal linkage between events observed and the administration of Lioresal Intrathecal cannot be reliably assessed in many cases and many of the adverse events reported are known to occur in association with the underlying conditions being treated.
Physical therapy may also help ease the pain of NDPH. For some people, NDPH may persist for several years or longer; for others, it may go away much earlier. Poison Control Centre for the most current information. 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 are usually more sensitive than younger adults to the effects of baclofen.
You probably remember exactly when your pain started. New daily persistent headaches NDPH begin without warning and go on for 3 months or longer. Lioresal Intrathecal is administered by intrathecal injection. Changing drug or decreasing drug concentrations - Rinse the reservoir twice between solutions when changing drug or decreasing drug concentrations in the pump reservoir. A significant amount of drug may be present in the pump reservoir after emptying the pump. This residual volume cannot be removed by emptying the pump. Rinsing the reservoir between solutions minimizes the amount of drug in this residual volume but does not eliminate it. Failure to account for residual drug in the pump reservoir can result in a concentration that is different than intended and a clinically significant or fatal drug underdose or overdose. Program a bridge bolus after rinsing the reservoir twice. The bridge bolus advances the remaining old drug the drug left in the pump tubing, catheter access port, and catheter after emptying and refilling the pump to the catheter tip at the prior flow rate.