Baclofen Toxicity Associated with Declining Renal Clearance after Ibuprofen

Dahlin, Patricia A.; George, J. C.

doi:10.1177/106002808401801006

Cited by 18 publications

(3 citation statements)

References 18 publications

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“…Reports have also suggested that if ibuprofen drug therapy is initiated, and the patient develops signs of drug toxicity, this may be a sign of ibuprofen-induced renal insufficiency, which further lowers drug clearance. 53 On the other hand, drugs such as gentamicin do not produce an elevated elimination half-life and may be administered with standardized dosing intervals, taking into consideration alterations in the other PK criteria.…”

Section: Pharmacokinetic Alterations In Spinal Cord Injury H Mestre Ementioning

confidence: 99%

Spinal cord injury sequelae alter drug pharmacokinetics: an overview

et al. 2011

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Study design: Literature review. Objectives: Critical review of the literature published on the physiological alterations caused by spinal cord injury (SCI) and their effect on the pharmacokinetic parameters of commonly employed drugs. The review introduces the most recent treatment protocols of a variety of drugs, enabling the modern clinician to apply efficacious and cost-effective solutions to the pharmacological treatment of SCI patients. Methods: Studies published in international indexed journals up to January 2011 were selected from the PubMed database. Results: The review evaluated the sequelae of SCI and their effect on pharmacological processes. The results demonstrated that these alterations affected the pharmacokinetics of drugs commonly administered to SCI patients, such as antibiotics, muscle relaxants, immunosuppressants and analgesics. Conclusion: There are multiple etiologies to SCI and patients present with varying degrees of impairment. Factors such as level of injury and completeness of the injury create a very heterogeneous population within the SCI community. The heterogeneity of this population creates a problem when trying to standardize pharmacokinetic (PK) parameters. It is because of this that specific physiological alterations must be linked to changes in PK and be identified within the clinical setting. This relationship between physiology and PK enables the clinician to be alert for possible pharmacological complications in individual patients based on their clinical manifestations. Future research should aim to develop rigorous therapeutic guidelines tailored to the diverse manifestations of SCI so as to provide effective, affordable and safe pharmacotherapy.Spinal Cord (2011) 49, 955-960;

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Section: Pharmacokinetic Alterations In Spinal Cord Injury H Mestre Ementioning

confidence: 99%

Spinal cord injury sequelae alter drug pharmacokinetics: an overview

et al. 2011

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“…A similar case of baclofen-induced encephalopathy linked to concurrent use with ibuprofen was reported in the literature. In the case mentioned above, an associated acute kidney injury may have increased the risk of toxicity [ 15 ]. The evidence supporting a direct adverse drug interaction between NSAIDs and baclofen in the absence of impaired renal function is not clearly substantiated.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Baclofen-Induced Encephalopathy in a Healthy Young Adult: Is Baclofen Toxicity Dose-Dependent?

Ibeson¹,

Nwosu²,

Donenfeld³

et al. 2021

Cureus

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Baclofen is a commonly used medication for managing muscle spasticity with the potential of causing lifethreatening adverse effects, including encephalopathy as well as withdrawal symptoms including confusion and hallucinations following abrupt discontinuation. Severe toxicity with baclofen is common in patients with kidney disease, hence the importance of dose reduction and monitoring in patients with renal impairment. This article reports a case of encephalopathy with low-dose baclofen in an otherwise healthy young adult concurrently taking ibuprofen and baclofen and aims to underscore the importance of potential drug interaction and patient education when initiating baclofen.

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“…Medications that affect renal function can also potentiate baclofen toxicity. Therefore, clinicians should be vigilant in identifying the potential risk of renal dysfunction when prescribing baclofen [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Encephalopathy and Hypotonia due to Baclofen Toxicity in a Patient with End-Stage Renal Disease

et al. 2015

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Patient: Female, 57Final Diagnosis: Baclofen toxicitySymptoms: Encephalopathy • hypotoniaMedication: BaclofenClinical Procedure: HemodialysisSpecialty: Critical CareObjective:Unusual or unexpected effect of treatmentBackground:Baclofen is a centrally acting gamma-aminobutyric acid agonist used for the symptomatic relief of skeletal muscle spasm and spasticity in traumatic spinal cord lesions, multiple sclerosis, cerebral palsy, and stroke. It is also used in the treatment of chronic hiccups and cocaine abuse. Baclofen-induced central nervous system depression is rare at the usual therapeutic doses. However, patients with impaired renal function are at a higher risk of developing baclofen toxicity, even at a lower dose.Case Report:A 57-year-old woman with end-stage renal disease on hemodialysis was admitted to our emergency department with progressive confusion and a generalized decrease in muscular tone. There was no obvious metabolic or infectious etiology that could have explained her condition. A comprehensive laboratory and imaging workup was negative. A review of her medication showed that she had recently been prescribed baclofen for muscular spasm. She was diagnosed with baclofen toxicity and was treated with emergent hemodialysis, which improved her mental status and her decreased muscle tone. Repeated sessions of hemodialysis administered on her second and third days of admission ultimately produced sustained clinical improvement and a complete return to her baseline mental status. She was subsequently discharged home with instructions to stay off baclofen.Conclusions:Baclofen toxicity is an under-diagnosed condition, especially in patients with renal dysfunction. Physicians should consider baclofen toxicity in patients with suboptimal kidney function on baclofen who present with altered mental status. Emergent hemodialysis and intensive care unit monitoring is recommended.

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Baclofen Toxicity Associated with Declining Renal Clearance after Ibuprofen

Cited by 18 publications

References 18 publications

Spinal cord injury sequelae alter drug pharmacokinetics: an overview

Spinal cord injury sequelae alter drug pharmacokinetics: an overview

Low-Dose Baclofen-Induced Encephalopathy in a Healthy Young Adult: Is Baclofen Toxicity Dose-Dependent?

Encephalopathy and Hypotonia due to Baclofen Toxicity in a Patient with End-Stage Renal Disease

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