Baclofen is often used as a muscle relaxant in many
patients. It has a half life of 3-7 hours and 80% excreted by the kidneys. It is extremely important to dose adjust in
CKD and avoid use in ESRD patients. Dialysis is a good mechanism to remove the
agent as well in-case of ingestions and overdoses.
A recent case published in AJKD highlights this important drug
related interaction in CKD and ESRD patients.
The authors describe two
excellent clinical algorithms.
The first algorithm discusses dose adjustments.
If GFR>90, no dose adjustment necessary
If GFR 60-90, decrease initial dose by 1/3
If GFR 30-60, decrease dose by ½ and watch for mental status changes
If on RRT or GFR<30, avoid use
If GFR>90, no dose adjustment necessary
If GFR 60-90, decrease initial dose by 1/3
If GFR 30-60, decrease dose by ½ and watch for mental status changes
If on RRT or GFR<30, avoid use
The second algorithm discusses if there is a known baclofen
toxicity( seizures, hypotenia, encephalopathy, etc.)
If severe AKI, CKD or ESRD- start daily HD or CRRT
If normal renal function or mild AKI but with respiratory depression or seizures- start daily HD or CRRT
If normal renal function or mild AKI and no severe symptoms- no dialysis
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