Baclofen-induced toxic encephalopathy in end-stage renal disease: should we be more careful?

Baclofen is a highly used centrally acting GABA agonist that continues to be an effective therapy for symptomatic relief of skeletal muscle spasm and spasticity in traumatic spinal cord lesions, multiple sclerosis, cerebral palsy, stroke and chronic hiccups and has recently become popular as recreational drug. The renally dependent excretion determines the circulating concentrations and guides effective dosing to decrease adverse reactions. Caution should be considered in administering baclofen to patients with decreased renal function. We present a patient with end stage renal disease on hemodialysis with recent baclofen ingestion who presented with toxic encephalopathy that was resolved with additional dialysis sessions.