From the Guidelines
Baclofen is generally considered safe for use in patients with Parkinson's disease, although its efficacy as a monotherapy is limited [ 1 ].
Key Considerations
- When used in conjunction with other medications, baclofen doses should be carefully monitored to minimize potential adverse interactions.
- Baclofen can be used to treat spasticity resulting in pain, poor skin hygiene, or decreased function [ 1 ].
- The use of baclofen in patients with Parkinson's disease should be approached with caution, particularly when co-administering with other central nervous system depressants, such as benzodiazepines, due to potential additive sedative effects.
Important Medication Interactions
- Dopaminergic medications, such as levodopa/carbidopa or pramipexole, can be used in conjunction with baclofen, with doses ranging from 10-40 mg/day generally well-tolerated [ 1 ].
- Tizanidine and dantrolene are alternative options for treating spasticity, and may be considered in patients who do not respond to baclofen or experience adverse effects [ 1 ].
- Intrathecal baclofen may be considered for patients with chronic spasticity resulting in pain, poor skin hygiene, or decreased function [ 1 ].
From the FDA Drug Label
Baclofen tablets are useful for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. ... The efficacy of baclofen in stroke, cerebral palsy, and Parkinson’s disease has not been established and, therefore, it is not recommended for these conditions.
- Key Points:
- Baclofen is not indicated for Parkinson's disease
- Efficacy in Parkinson's disease has not been established
- The use of baclofen in patients with Parkinson's disease is not recommended 2
From the Research
Safety of Baclofen in Patients with Parkinson's Disease
- There is limited research directly addressing the safety of baclofen in patients with Parkinson's disease and their medication regimens 3, 4, 5, 6, 7.
- A study published in the European journal of pharmacology in 2006 found that baclofen did not affect neuronal survival at concentrations of 2 and 4 mg/ml, suggesting it may be safe at clinically used concentrations 3.
- However, other studies have reported adverse effects associated with baclofen use, including sedation, motor impairment, and toxicity in patients with renal disease 4, 5, 6, 7.
- Patients with end-stage renal disease are particularly prone to baclofen intoxication due to the drug's reliance on renal excretion, and healthcare providers are advised to exercise caution when prescribing baclofen to these patients 6, 7.
- The use of positive allosteric modulators (PAMs) of the GABA(B) receptor, such as CMPPE, may offer an alternative to baclofen with a potentially improved side-effect profile 4, 5.
Considerations for Patients with Parkinson's Disease
- Patients with Parkinson's disease may be more susceptible to the adverse effects of baclofen due to their underlying neurological condition and potential interactions with other medications.
- Healthcare providers should carefully weigh the potential benefits and risks of baclofen use in patients with Parkinson's disease and consider alternative treatment options when possible.
- Close monitoring of patients with Parkinson's disease who are taking baclofen is recommended to minimize the risk of adverse effects and ensure safe use 3, 4, 5, 6, 7.