2010 Volume 1 Issue 1 Pages 180-183
The skeletal muscle relaxant, Baclofen, is emerging as a potentially effective treatment for intractable hiccups. However, there have been several reports describing the neurotoxicity of a low dose of Baclofen in patients with chronic renal failure, especially those with intractable hiccups. However, relationship between pharmacokinetic data and neurotoxicity of Baclofen in patients with chronic renal failure has not yet been well elucidated. We encountered a 74-year-old male on hemodialysis who rapidly developed side effects including coma, respiratory depression and tonic-clonic convulsion after taking a single 10 mg does of Baclofen for intractable hiccups. We performed hemodialysis to remove Baclofen under ventilator management. After the first hemodialysis for four hours, convulsion resolved and the plasma concentration of Baclofen decreased from 162 ng/mL to 78.9 ng/mL. The plasma concentration of the Baclofen did not show any further decrease without dialysis; that before the second hemodialysis was 83.7 ng/mL and after the second hemodialysis, the concentration was 31.8 ng/mL. Consciousness gradually recovered after the second dialysis. The present case indicates that Baclofen even at a therapeutic plasma level can cause serious neurological side effects in patients with renal failure. This suggests that patients with renal failure are susceptible to neurotoxic effects of Baclofen. Cautious dose reduction is recommended when treating intractable hiccups with Baclofen in patients with renal failure.
