Baclofen

CLINICAL USE

Chronic severe spasticity of voluntary muscles

DOSE IN NORMAL RENAL FUNCTION

5 mg, 3 times a day; increase dose gradually up to 100 mg/day

PHARMACOKINETICS

Molecular weight :213.7

%Protein binding :30

%Excreted unchanged in urine : 70

Volume of distribution (L/kg) :0.7

half-life – normal/ESRD (hrs) :3–4/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : 5 mg, 3 times a day and titrate according to response

10 to 20 : 5 mg, twice a day and titrate according to response

<10 : 5 mg, once a day and titrate according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Dialysed.1 Dose as in GFR

<10 : mL/min

HDF/high flux :Dialysed.1 Dose as in GFR

<10 : mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anti-arrhythmics: enhanced muscle relaxant effect with procainamide

Antidepressants: enhanced muscle relaxant effect with tricyclics

Antihypertensives: enhanced hypotensive effect

ADMINISTRATION

Reconstition

–

Route

Oral, intrathecal injection

Rate of Administration

–

Comments

Take with or after food

Baclofen can be given intrathecally (at doses greatly reduced compared with oral dose), by bolus injection, or continuous infusion. Individual titration of dosage is essential due to variability in response. Test doses must be given. Maintenance dose: 10–2000 micrograms/day

OTHER INFORMATION

ithdraw treatment gradually over 1–2 weeks to avoid anxiety and confusional state, etc

Drowsiness and nausea frequent at the start of therapy

Use with caution as a case report of encephalopathy has been reported in a haemodialysis patient.

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