Baclofen unerotoxicity in a chronic haemodialysis patient

Bassilios, Nader; Launay‐Vacher, Vincent; Mercadal, Lucile; Deray, Gilbert

doi:10.1093/ndt/15.5.715

Cited by 24 publications

(21 citation statements)

References 8 publications

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“…The elimination half-life of baclofen is 2–6 h for therapeutic oral doses in healthy volunteers and elderly patients [4,5], but half-life increases with renal insufficiency [6,7,8,9,10]. Baclofen has a limited hepatic metabolism.…”

Section: Introductionmentioning

confidence: 99%

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Baclofen Toxicity in Patients with Advanced Nephropathy: Proposal for New Labeling

et al. 2011

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Background: Despite several reports in the literature of baclofen toxicity in patients with renal dysfunction, the drug is being used for many patients. Methods: Herein we report a case of baclofen-induced encephalopathy in a patient with pre-end-stage renal disease and review the literature regarding the magnitude of baclofen toxicity in patients with renal insufficiency. A Medline search for studies in English was performed. Twenty-one case reports involving 41 patients (including our patient) were identified. Results: The majority of patients were elderly (62.5% above 60 years) males (56.3%) on dialysis (62.9%). Neurotoxicities were almost always present at presentation. Manifestations of baclofen toxicity usually started 2–3 days after starting baclofen; however, periods as long as 16 weeks have been reported. The daily dose of baclofen ranged from 5 to 60 mg with a mean dose of 20 mg. Hemodialysis (HD) was the most common treatment modality used for drug elimination (65.7%). The recovery time ranged from 2 h in patients who received HD, to 8 days with conservative treatment. Conclusion: The literature does not mention a clear recommendation about baclofen safety and dose adjustment, or a minimum level of kidney function below which the drug should not be used.

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Section: Introductionmentioning

confidence: 99%

“…Therefore, a significant reduction in the daily dose is mandatory in patients with renal insufficiency. Most nephrologists consider baclofen to be a drug that should not be used in patients with end-stage renal disease (ESRD) [7,8,11]. …”

Section: Introductionmentioning

confidence: 99%

Baclofen Toxicity in Patients with Advanced Nephropathy: Proposal for New Labeling

et al. 2011

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“…According to Ghose et al, baclofen plasma half-life time is 3.5 hours in therapeutic doses, and in the case of overdose, there is a 5-fold increase of plasma half-life [9]. In patients with endstage renal disease (ESRD), the half-life of baclofen is also significantly increased, even with therapeutic doses [4,22]. Hemodialysis in such patients resulted in a good clinical outcome [4,22].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with endstage renal disease (ESRD), the half-life of baclofen is also significantly increased, even with therapeutic doses [4,22]. Hemodialysis in such patients resulted in a good clinical outcome [4,22]. Clearance for baclofen in patients who underwent intermittent haemodialysis (iHD) varied between 0.195/h -0.336/h [4,23,24].…”

Section: Discussionmentioning

confidence: 99%

Correlation between the single, high dose of ingested baclofen and clinical symptoms

Anand

Zając

Waldman

et al. 2017

Ann Agric Environ Med.

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Introduction and Objectives. Baclofen is a drug used mainly to treat muscle spasticity. Its overdose can lead to lifethreatening clinical symptoms, including acute respiratory failure requiring mechanical ventilation. The aim of this study was to assess the prevalence of selected clinical symptoms associated with baclofen poisoning comparing to an ingested dose. Materials and method. 60 cases of oral baclofen poisoning were analyzed. Gender, age distribution, and correlation between the dose of ingested baclofen were studied, as well as and following clinical parameters: degree of altered consciousness, heart rate, blood pressure, presence of acute respiratory failure, duration of mechanical ventilation, and presence of psychotic symptoms. Results. The study found statistically significant correlations between dosage of ingested baclofen and presence of acute respiratory failure, as well as duration of mechanical ventilation. No statistically significant correlations were found between the dose of ingested baclofen and presence of hypertension, bradycardia, acute psychotic symptoms, or level of consciousness disturbance. However, it was found that patients who suffered from hypertension, bradycardia, and altered mental status ingested a larger dose of baclofen. Conclusions. There is a statistically significant correlation between the dose of ingested baclofen and the presence of acute respiratory failure, and duration of mechanical ventilation. Patients who have taken a single dose of baclofen of 200 mg, or higher, should be managed in centres able to provide continuous monitoring of life functions. Those with a higher level of a single dose of baclofen ingestion (>500 mg), should be hospitalized in a Toxicology Unit or Intensive Care Unit able to provide airway support and mechanical ventilation.

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“…Son dönem böbrek yetersizliği olan hastalarda baklofen birikimi olduğu ve yarılanma ömrünün uzadığı belirtilmektedir (19). Yapılan birçok çalışmada renal yetersizliği olan ciddi baklofen toksisite olgularında hemodiyaliz uygulamaları ile serum baklofen kosantrasyonun hızla düştüğü, baklofen yarılanma ömrünün kısaldığı ve klinik semptomların hızla iyileştiği gösterilmiştir (20)(21)(22)(23)(24). Kısıtlı sayıda çalışmada ise normal renal fonksiyonu olan baklofen entoksikasyonu olgularında da hemodiyaliz ile yine aynı faydaların sağlandığı belirtilmektedir (25,26).…”

Section: Discussionunclassified