Practice Lesson of the Week

Reduced level of consciousness from baclofen in people with low kidney function

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4559 (Published 31 December 2009) Cite this as: BMJ 2009;339:b4559
  1. W Su, clinical scholar ,
  2. C Yegappan, associate professor ,
  3. E J F Carlisle, associate professor ,
  4. C M Clase, associate professor
  1. 1Department of Medicine, McMaster University, Hamilton, ON, Canada L8N 1Y2
  1. Correspondence to: C M Clase clase{at}mcmaster.ca
  • Accepted 5 July 2009

Baclofen may lead to reversible neurological changes and coma in people with low kidney function

Baclofen is commonly used to treat spasticity,1 dysfunctional voiding, intractable hiccups,2 palatal myoclonus, trigeminal neuralgia, and addiction to opiates, alcohol, or cocaine.3 Accumulation in people with low kidney function leads to neurological deterioration and coma. This problem occurred in four patients at our hospital within a year. We report a typical case and systematically review the literature.

Case report

A 61 year old woman with end stage renal disease who was receiving haemodialysis was admitted with Staphylococcus epidermidis discitis; vancomycin and narcotic analgesics were started. She had a history of hypertension, diabetes, and calciphylaxis. In her fourth week in hospital, oral baclofen 5 mg three times daily was prescribed for back pain and muscle spasms. Within 12 hours she became disoriented, and by 36 hours had deteriorated to a Glasgow coma score of 8. Her other drugs (hydromorphone 5 mg subcutaneously every four hours, pregabalin 50 mg daily, amitriptyline 10 mg at night, lorazepam 1 mg at night, irbesartan, repaglinide, and vancomycin) had not changed. Blood pressure was 140/75, temperature 37.0ºC, heart rate 70 beats/minute, and oxygen saturation 99% on room air. There were no focal neurological deficits. The remainder of the examination was consistent with known problems. Full blood count, electrolytes, and concentrations of glucose, calcium, phosphorus, and magnesium were similar to her previous values and in …

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