Baclofen is a drug used primarily as a muscle relaxant for spasticity. Baclofen overdose or withdrawal can be life threatening. Used as an adjunct in the treatment of painful muscle spasticity, clonus and stiffness caused by spinal cord disorders such as multiple sclerosis, cerebral palsy and spinal cord injury. This activity provides an overview of clinical management related to epidemiology, pathophysiology, clinical manifestations, diagnosis, and essentials required by members of a professional team managing the care of patients with baclofen poisoning. FDA-approved baclofen is primarily used as an anticonvulsant and muscle relaxant. Used as an adjunct in the treatment of painful muscle spasticity, clonus and stiffness caused by spinal cord disorders such as multiple sclerosis, cerebral palsy and spinal cord injury. It is most commonly given orally, but in severe or chronic cases, it can also be given centrally using an implantable intrathecal pump. Chronic use of baclofen can lead to withdrawal if stopped abruptly. Baclofen overdose or withdrawal can be life threatening. This review article summarizes the clinical toxicity of baclofen, baclofen withdrawal, and principles of acute management. Baclofen is a synthetic derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Therapeutic effects occur at plasma concentrations between 0.1 and 0.4 mg/l. The recommended starting oral dose for adults is 5 mg three times daily (usually the maximum daily dose is 80 mg). Severe toxicity may occur at doses above 200 mg. Because baclofen is excreted by the kidneys, impaired renal function increases the risk of baclofen toxicity. Oral overdose can be serious, but intrathecal pump failure carries a high risk of poor clinical outcome. The incidence of side effects at therapeutic doses of baclofen ranges from 10% to 65%. The most common side effects are drowsiness and dizziness. Complications of intrathecal baclofen pumps are high, with approximately 21% of pump recipients experiencing some side effects. In the group of intentional overdoses of oral baclofen, the median age was 35 years of her age and 56% were female. B. Alcohol use disorders, refractory hiccups, gastroesophageal reflux and anxiety disorders, and cases of intentional and accidental baclofen poisoning are increasing with the increase in off-label use of baclofen, including: In a French retrospective study looking at intentional baclofen overdoses, he increased from 8 in 2001 to 91 in 2015. US data show a similar trend. In 2020, 4,786 baclofen exposures were reported to the US Centers for Poison Control. Of these, 980 serious consequences and 4 fatalities occurred. Baclofen is a G protein-mediated GABA B receptor agonist. GABA B receptors are located pre- and postsynaptically in the brain and spinal cord. At therapeutic levels, baclofen acts in the spinal cord. It binds presynaptically and reduces calcium influx, which impairs neurotransmitter release. In postsynaptic neurons, baclofen causes potassium efflux and cellular hyperpolarization, producing an inhibitory effect. These effects lead to reduced spasticity at the spinal level. In overdose, baclofen loses its specificity for spinal cord receptors and exerts greater effects on receptors in the central nervous system (CNS). This can lead to autonomic abnormalities such as central nervous system depression, respiratory depression, flaccid paralysis, hypotension and hypertension, bradycardia and tachycardia, and seizures. Central nervous system depression can be so severe that it resembles brain death. In particular, GHB (gamma hydroxybutyrate), an illegal drug traditionally used in nightclubs and drug-assisted sexual assaults, is structurally similar to GABA and baclofen and can cause similar symptoms when overdose.