Treatment of Intractable Hiccup in Haemodialysis Patients with Baclofen

Hadjiyannacos, Dimitrios; Vlassopoulos, Dimosthenis; Hadjiconstantinou, Valsamakis

doi:10.1159/000046290

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…Krahn and Penner [23] considered baclofen as one of the agents of choice in such conditions based on knowing its safety and efficacy at that time. Hadjiyannacos et al [24] reported that using a small dose of baclofen (2.5 mg twice daily) was not associated with side effects in 2 patients on HD but using larger doses (5 mg twice daily) was associated with neurotoxicity. So they concluded that it is safe to use small baclofen doses in patients with ESRD.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…Most of these cases describe successful use of baclofen or gabapentin in various clinical settings. [2][3][4][5][6][7][8][9][10] Additional cases specifically involve patients with cancer who were successfully treated with gabapentin, baclofen, or methylphenidate. [11][12][13][14] Other case reports describe successful use of chlorpromazine, olanzapine, sertraline, nimodipine, amantadine, and midalozam as monotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…However, several case reports have been previously published that describe various successful pharmacotherapeutic and nonpharmacotherapeutic regimens. Most of these cases describe successful use of baclofen or gabapentin in various clinical settings . Additional cases specifically involve patients with cancer who were successfully treated with gabapentin, baclofen, or methylphenidate .…”

Section: Discussionmentioning

confidence: 99%

Olanzapine and Baclofen for the Treatment of Intractable Hiccups

2013

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Intractable hiccups are a relatively uncommon condition characterized by involuntary, spasmodic contractions of the diaphragm. This type of hiccups generally has a duration of more than 1 month. We describe a 59-year-old kidney transplant recipient with a complicated medical history (atrial fibrillation, chronic renal failure, type 2 diabetes mellitus, gastroesophageal reflux, gout, hypertension, hyperlipidemia, and obstructive sleep apnea) who developed intractable hiccups that significantly affected his quality of life. Despite an extensive gastrointestinal and pulmonary evaluation, and treatment failures with several different drug regimens--metoclopramide, desipramine, amantadine, cyclobenzaprine, phenytoin, and lorazepam--his hiccups were eventually controlled with a combination of baclofen and low-dose olanzapine therapy. Baclofen is a c-aminobutyric acid (GABA) analog that contains a phenylethylamine moiety. It is hypothesized that having both GABA and phenylethylamine properties activates inhibitory neurotransmitters, most notably GABA, which may in turn block the hiccup stimulus. The exact mechanism through which olanzapine is effective in patients with hiccups is not fully understood. It is thought that the effect is, in part, due to serotonin augmenting phrenic motoneuronal activity on the reflex arcs involved in the generation of hiccups within the spinal cord. In addition, since olanazapine is a dopamine antagonist, particularly a dopamine D₂-receptor antagonist, this could also have played a role in its effectiveness in treating our patient. Strong evidence for a specific treatment regimen for intractable hiccups is lacking in the primary literature. Our case report adds to the available literature, as there are currently no published data on the use of combination therapy for the treatment of intractable hiccups, and the combination of baclofen and olanzapine significantly improved our patient's quality of life.

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“…9 In patients receiving chronic hemodialysis, baclofen should be avoided or, if no suitable alternative is available, limited to not more than 5 mg/d. 10…”

Section: To the Editormentioning

confidence: 99%