From the FDA Drug Label
c. Impaired Renal Function:Because baclofen is primarily excreted unchanged through the kidneys, it should be given with caution, and it may be necessary to reduce the dosage.
Baclofen use in patients with kidney failure is not recommended without caution. The drug should be given with caution, and it may be necessary to reduce the dosage in patients with impaired renal function, as it is primarily excreted unchanged through the kidneys 1.
From the Research
Baclofen is not recommended for patients with kidney failure, especially those with severely reduced kidney function (estimated glomerular filtration rate < 30mL/min/1.73m2) or on renal replacement therapy, due to the high risk of toxicity and adverse effects. The use of baclofen in patients with kidney failure requires careful consideration of the potential risks and benefits, as the drug is primarily eliminated through the kidneys and impaired kidney function can lead to drug accumulation and toxicity 2.
Key Considerations
- Baclofen's half-life is significantly prolonged in kidney failure, increasing from the normal 3-4 hours to potentially 15-35 hours in patients with renal impairment, which substantially increases the risk of adverse effects 3.
- Patients with severely impaired renal function are at high risk of developing baclofen toxicity, even at low doses, and may experience severe acute complications such as seizures and respiratory depression 3.
- Hemodialysis is effective in alleviating the clinical symptoms and shortening the recovery time for patients with baclofen toxicity, but prompt recognition and treatment are essential to prevent long-term damage 3, 4.
- Alternative muscle relaxants or pain management strategies may be considered for patients with severe kidney failure, as the risks associated with baclofen use may outweigh the benefits 2, 5.
Recommendations
- Avoid using baclofen in patients with severely reduced kidney function (estimated glomerular filtration rate < 30mL/min/1.73m2) or on renal replacement therapy 2.
- For patients with moderately reduced kidney function (estimated glomerular filtration rate 30-60mL/min/1.73m2), consider reducing the baclofen dose to minimize the risk of toxicity 2, 6.
- Close monitoring for side effects is essential, including drowsiness, confusion, muscle weakness, and respiratory depression, which can be more pronounced in kidney failure patients 3, 2.