Single-dose baclofen-induced neurotoxicity in a patient with end stage renal disease: case report

• Published in: BMC nephrology 2018-12, Vol.19 (1), p.352-4, Article 352
• Main Authors: Khazneh, Emad, Shamlawi, Alaa, Jebrin, Kamel, Hamdan, Zakaria, Sawalmeh, Osama
• Format: Article
• Language: English
• Subjects: Baclofen; Blood pressure; Case Report; Case reports; Chronic kidney disease; Consciousness; Drug dosages; Drug therapy; Emergency medical care; End stage renal disease; ESRD; Excretion; Family medical history; Hemodialysis; Hemorrhage; Hospitals; Hypertension; Internal medicine; Intoxication; Kidney diseases; Medical imaging; Medicine; Multiple sclerosis; Nephrology; Neurotoxicity; NMR; Nuclear magnetic resonance; Pain; Patients; Potassium; Renal function; Spasticity; Toxicity; γ-Aminobutyric acid B receptors
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-018-1167-z

Baclofen is a centrally acting GABA receptor agonist and it is used widely for the treatment of spasticity, persistent hiccups and multiple sclerosis. The renal system is the main route of excretion, thus people with suboptimal renal function are prone to baclofen intoxication. Multiple doses of baclofen have been associated with toxicity, but it is very unusual that single dose can do so. A 47 year old female patient with end stage renal disease (ESRD) presented with a sudden onset of altered mental status and state of unconsciousness after the ingestion of one tablet of baclofen 25 mg. All other possible causes were ruled out and a diagnosis of baclofen toxicity was considered. The patient showed dramatic improvement after an extra two sessions of hemodialysis. We highly recommend that more educational efforts are made for health care professionals about the possible risk of baclofen toxicity among kidney-impaired patients. We also recommend avoiding baclofen use if evidence of chronic renal disease is present and to seek other alternatives for pain management.