Baclofen-induced neurotoxicity in a dialysis patient managed with continuous venovenous hemodialysis: A case report and literature review

Abstract Despite documented cases of baclofen toxicity in individuals with kidney disease, the drug is widely prescribed for various medical conditions, primarily spasticity, hiccups, and multiple sclerosis. Baclofen, a gamma-aminobutyric acid derivative, relies on renal excretion, rendering those with impaired kidney function susceptible to toxicity – a concern often underestimated by health-care providers. Adverse reactions, including single or double doses, are well documented in addition to multi-dose toxicity. This report discusses a case of baclofen-induced neurotoxicity in an end-stage renal disease patient undergoing dialysis, highlighting the subsequent management with continuous venovenous hemodialysis. In addition, it provides a comprehensive review of existing literature on baclofen toxicity in cases of renal insufficiency. Strikingly, the literature lacks clear guidelines regarding baclofen safety, dose adjustments, or renal function thresholds for contraindication. This contribution aims to augment understanding of this critical issue, emphasizing the need for heightened awareness and careful consideration of baclofen use in patients with kidney disease.