Acute Intoxication After Baclofen Administration: A Review of the Literature and Methodological Proposals

Abstract

first_pageDownload PDFsettingsOrder Article Reprints Open AccessReview Acute Intoxication After Baclofen Administration: A Review of the Literature and Methodological Proposals by Giuseppe Davide Albano 1,*ORCID,Mauro Midiri 1,*ORCID,Péter Attila Gergely 2ORCID,Tamás Gergő Harsányi 2,Kálmán Racz 2,Alessandra Matilde Nivoli 3ORCID,Roberto Buscemi 1,Stefania Zerbo 1ORCID,Antonina Argo 1ORCID andClaudia Trignano 4ORCID 1 Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy 2 Department of Forensic Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary 3 Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy 4 Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy * Authors to whom correspondence should be addressed. Toxics 2025, 13(11), 999; https://doi.org/10.3390/toxics13110999 Submission received: 20 October 2025 / Revised: 11 November 2025 / Accepted: 18 November 2025 / Published: 20 November 2025 (This article belongs to the Special Issue Current Issues and Research Perspectives in Forensic Toxicology) Downloadkeyboard_arrow_down Browse Figures Versions Notes Abstract Baclofen intoxication, once rare, is now increasingly observed in clinical and forensic settings due to its expanding medical and off-label use. However, baclofen is not routinely included in standard postmortem toxicological panels and is usually tested only when explicitly requested. This selective approach, together with the lack of validated cut-offs and standardized interpretative protocols, complicates both clinical management and postmortem evaluation. A systematic review of the literature published between July 2005 and July 2025 was conducted according to PRISMA guidelines, including fatal and non-fatal baclofen intoxications with quantitative toxicological data. Analytical methods, biological matrices, concentration ranges, and clinical outcomes were compared to identify recurring patterns and interpretative gaps. A fatal intrathecal overdose case was also analyzed as a paradigmatic example of diagnostic and methodological challenges. In thirteen studies meeting inclusion criteria and comprising over 300 cases, reported blood concentrations ranged from 0.04 to 110 mg/L, with overlapping values between survivors and fatalities. The analysis revealed marked heterogeneity in matrices and methods, and a poor correlation between concentration and clinical severity, limiting the reliability of toxicological interpretation in both clinical and postmortem settings. Baclofen intoxication illustrates the challenges of interpreting toxicological data without harmonized analytical criteria and highlights the need for standardized procedures and shared reference databases to improve diagnostic and medico-legal accuracy.