Common muscle relaxant linked to fall-related hospitalizations in patients with CKD
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For patients with chronic kidney disease, higher doses of the muscle relaxant baclofen appeared to increase risk for hospitalization due to fall or hypotension, with primary care physicians being most likely to prescribe the medication.
“Baclofen is a popular muscle relaxant that is eliminated primarily unchanged in the urine,” Flory T. Muanda, MD, PhD, of Western University in London, Ontario, and colleagues wrote. “We recently reported a higher risk of encephalopathy in a cohort of 15,942 older adults with chronic kidney disease (CKD) who started baclofen at [at least] 20 mg/day vs. [less than] 20 mg/day; a higher risk was also observed in all baclofen users vs. non-users. In another study of patients receiving dialysis, [one] in 14 were hospitalized with encephalopathy within 3 days of starting baclofen.”
For this investigation, researchers assessed 30-day hospitalization risk with a fall, a fracture or hypotension in the cohort from the previous study (all participants were at least 66 years old and not receiving dialysis).
“20 mg/day is the median dose reported in cases of baclofen toxicity, and the median dose prescribed during the study period,” they noted.
Findings showed less than 5% of patients received the recommended starting dose of 7.5 mg or 5.5 mg per day, with 86% of prescribing physicians being PCPs (less than 1% were nephrologists).
Further, compared with starting the medication at less than 20 mg per day, the researchers found patients receiving 20 mg or greater had a higher risk of hospitalization with a fall (weighted risk ratio [wRR] = 1.38) and hypotension (wRR = 3.06).
When considering baclofen users vs. non-users, researchers observed patients taking high doses (20 mg per day or more) had a higher risk of hospitalization with a fall, fracture and hypotension, while low-dose users had a higher risk of hospitalization with a fall, but not fracture or hypotension.
“While comparison groups were well-balanced, residual confounding is still possible, and we did not account for dose changes in other medications such as opioids or benzodiazepines, which could influence study outcomes,” Muanda and colleagues concluded. “Nonetheless, the results of this study and others taken together suggest that baclofen should be used with caution in older adults with CKD, and only at low doses. To better protect patients with CKD, the product monograph should contain clear dose recommendations based on kidney function, and computerized medication-order entry warnings with dosing prompts are also recommended.”
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