Baclofen Contraindications
The only absolute contraindication to baclofen is hypersensitivity to the drug itself. 1
Absolute Contraindication
- Hypersensitivity to baclofen is the sole FDA-labeled absolute contraindication 1
- True allergic reactions to baclofen are rare, and some patients with adverse reactions to oral baclofen may be mistakenly classified as allergic when they could potentially tolerate intrathecal formulations 2
- Active infection is an absolute contraindication specifically for intrathecal baclofen therapy 2
Relative Contraindications and High-Risk Situations
Seizure Disorders
- Baclofen may potentiate seizures in certain populations, particularly young children with cerebral palsy 3
- In one pediatric series, 14% of children developed new-onset seizures after starting oral baclofen 3
- While not an absolute contraindication, seizure history should be thoroughly discussed before initiating therapy, especially for intrathecal administration 2
Hepatic and Renal Dysfunction
- Patients with hepatic or renal dysfunction require careful consideration, as these conditions affect drug clearance and increase risk of adverse effects 4
- Elderly patients are at higher risk for sedative and hypotensive effects and require cautious dosing 4
Perioperative Considerations
- Baclofen should never be abruptly discontinued perioperatively due to life-threatening withdrawal risks 4
- Continue baclofen preoperatively including on the day of surgery 4
- Abrupt withdrawal of intrathecal baclofen can cause high fever, altered mental status, rebound spasticity, muscle rigidity leading to rhabdomyolysis, multiorgan failure, and death 4
- Oral baclofen withdrawal produces visual and auditory hallucinations, anxiety, agitation, delirium, fever, tremors, tachycardia, and seizures 4
Psychosocial Factors (Intrathecal Baclofen)
- Unrealistic treatment goals 2
- Unmanageable mental health issues 2
- Psychosocial factors affecting compliance 2
- Financial burden that would prevent ongoing therapy 2
Special Anatomical Considerations (Intrathecal Baclofen)
- Vascular shunting for hydrocephalus is not a contraindication but may affect cerebrospinal fluid flow and requires discussion 2
- Prior abdominal or pelvic surgery should be evaluated before proceeding to intrathecal therapy 2
Critical Safety Warnings
Drug Interactions
- Tizanidine (a related GABA agonist) is absolutely contraindicated with ciprofloxacin and fluvoxamine due to severe drug interactions 4
- Baclofen increases sedation risk when combined with opioids or other CNS depressants 4
Stroke Patients
- Oral baclofen may cause significant sedation and has less impact on spasticity in stroke patients compared to other conditions 4
- Diazepam (another GABA agonist) is relatively contraindicated in stroke patients during the recovery period 4
Common Pitfalls to Avoid
- Do not mistake adverse reactions to oral baclofen for true allergy without proper evaluation 2
- Never discontinue baclofen abruptly in long-term users—this is potentially fatal 4, 5
- Do not use baclofen as first-line therapy without considering the significant CNS side effects (drowsiness, dizziness, sedation) 4
- Recognize that cognitive impairment is not a contraindication; baclofen may actually be preferred in cognitively impaired patients as it controls spasticity without the cognitive side effects of some oral medications 2