Abstract：Objective To explore the regularities and characteristics of adverse reactions induced by baclofen in patients with renal insufficiency so as to provide reference for rational clinical use of this drug. Methods The CNKI, VIP, Pubmed, Wiley and EBSCO database were searched to retrieve related articles published between 1990 and 2018 . The clinical data of baclofen induced adverse reactions in patients with renal diseases was collected and statistically analyzed. Results A total of thirty-one pieces of literature involving forty-eight cases were enrolled for analysis. The patients comprised twenty-eight males (58.33%) and twenty females (41.67%). Twenty-nine of them (61.70%) were above 60 and 43 of them (89.58%) were patients with ESRD. The adverse drug reactions induced by baclofen usually started within four days (77.08%). The daily dose of baclofen ranged from 5mg to 30mg. The major clinical manifestations were drowsiness, unconsciousness and coma. Of the forty-eight patients, four (8.33%)improved after drug discontinuation, six (12.50%) improved after peritoneal dialysis, and thirty-eight (79.17%) improved after hemodialysis. Conclusion Baclofen can lead to adverse drug reactions in the central nervous system of patients with renal insufficiency. Careful assessment of risk versus benefit is required when baclofen is used for patients with kidney disease. Patients taking baclofen must be monitored.
赵敏, 黄振光. 巴氯芬致肾功能不全者不良反应文献分析[J]. 中国药物警戒, 2020, 17(5): 296-299.
ZHAO Min, HUANG Zhenguang. Literature Review of Baclofen-induced Adverse Reactions in Patients with Renal Insufficiency. Chinese Journal of Pharmacovigilance, 2020, 17(5): 296-299.
[1] Boz C, Velioglu S, Ozmenoglu M, et al.Baclofen is effective in intractable hiccups induced by brainstem lesions[J]. NeurolSci,2001, 22(5): 409-409. [2] Himmelsbach FA, Kohler E, Zanker B, et al.Baclofen intoxication in chronic hemodialysis and Kidneytransplantation[J]. Deutsche medizinischeWochenschrift(1946),1992,117(19):733-737. [3] Lee TH, Chen SS, Su SL, et al.Baclofen intoxication: report of four cases and review of the literature[J]. Clinical neurophar-macology,1992, 15(1):56-62. [4] Chen KS, Bullard MJ, Chien YY, et al.Baclofen toxicity in patients with severely impaired renalfunction[J]. The Annals of pharmacotherapy,1997, 31(11):1315-1320. [5] Bassilios N, Launay-Vacher V, Mercadal L, et al.Baclofen neur-otoxicity [correction of unerotoxicity] in a chronic haemodialysi-patient[J]. Nephrology, dialysis, transplantation, 2000, 15(5):715-716. [6] Choo YM, Kim GB, Choi JY, et al.Severe respiratory depression by low-dose baclofen in the treatment of chronic hiccups in a patient undergoing CAPD[J].Nephron,2000, 86(4):546-547. [7] Hadjiyannacos D, VlassopoulosD,Hadjiconstantinou V. Treatment of intractable hiccup in Haemodialysis patients with baclofen[J].American journal of nephrology,2001, 21(5):427-428. [8] KroczakM,Rakus A. Toxic effects of baclofen in a patient with chronic renal insufficiency[J]. Przeglad lekarski,2001, 58(4):364-366. [9] Yung-Chang C, Chin-Tung C, Ji-Tseng F, et al.Baclofen neurotoxicity in uremic patients: is continuous ambulatory peritoneal dialysis less effective than intermittent hemodialysis[J]. J Renal Failure,2003, 25(2): 297-305. [10] Wu VC, Lin SL, Lin SM, et al.Treatment of baclofen overdose by haemodialysis: a pharmacokinetic study[J].Nephrology, dialysis,transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2005, 20(2):441-443. [11] Chou CL, Chen CA, Lin SH, et al.Baclofen-induced neurotoxicity in chronic renal failure patients with intractable hiccups[J].Southern medical journal,2006, 99(11):1308-1309. [12] Lois F, Wallemacq P, de Tourtchaninoff M, et al. Prolonged unconsciousness in a patient on automated peritoneal dialysis[J].European journal of emergency medicine: official journal of the European Society for Emergency Medicine,2006, 13(6):361-363. [13] Brvar M, Vrtovec M, Kovac D, et al.Haemodialysis clearance of baclofen[J].European journal of clinical pharmacology, 2007,63(12):1143-1146. [14] Su W, Yegappan C, Carlisle EJ, et al.Reduced level of consciousness from baclofen in people with low kidney function[J]. BMJ (Clinical research ed),2009(339): 4559. [15] El-Husseini A, Sabucedo A, Lamarche J, et al.Baclofen toxicity in patients with advanced nephropathy: proposal for new labeling[J].American journal of nephrology,2011, 34(6):491-495. [16] Mousavi SS, MousaviMB,Motemednia F. Baclofen-induced encephalopathy in patient with end stage renal disease: Two case reports[J].Indian journal of nephrology,2012, 22(3):210-212. [17] Lee J, Shin HS, Jung YS, et al.Two cases of baclofen-induced encephalopathy in hemodialysis and peritoneal dialysis patients[J].Renal failure,2013, 35(6):860-862. [18] Dang DH, Carter AL, Olin JL, et al.Baclofen-induced encepha-lopathy in an older patient with stage 2 chronic kidney disease[J].Journal of the American Pharmacists Association :JAPhA,2015, 55(2):117-118. [19] Ijaz M, Tariq H, Kashif M, et al.Encephalopathy and hypotonia due to baclofen toxicity in a patient with end-stage renal disease[J].The American journal of case reports,2015,16:232-235. [20] Meillier A, Heller C,Patel S. Baclofen-Induced Encephalopathy in End Stage Renal Disease[J/OL]. Case reports in medicine,2015[2018-01-29].heeps://doi.org/10.1155/2015/203936. [21] Roberts JK, WestphalS,Sparks MA. Iatrogenic Baclofen Neuro-toxicity in ESRD:Recognition and Management[J].Seminars in dialysis,2015, 28(5):525-529. [22] Niehaus MT, Elliott NC,Katz KD.Baclofen Toxicity Causing Acute, Reversible Dyskinesia[J]. Journal of medical toxicology:official journal of the American College of Medical Toxicology,2016, 12(4):406-407. [23] Radhakrishnan H.Baclofen-induced neurotoxicity in a patient with end-stage renal disease[J].Saudi journal of kidney diseases and transplantation , 2016, 27(3):595-597. [24] Porter LM, Merrick SS,Katz KD.Baclofen Toxicity in a Patient with Hemodialysis- Dependent End-Stage Renal Disease[J].The Journal of emergency medicine,2017, 52(4):e99-e100. [25] Wolf E, Kothari NR, Roberts JK, et al.Baclofen Toxicity in Kidney Disease[J].J American Journal of Kidney Diseases,2018,71(2):275-280. [26] Khazneh E, Shamlawi A, Jebrin K, et al.Single-dose baclofen-induced neurotoxicity in a patient with end stage renal disease:case report[J].BMC nephrology,2018, 19(1):352. [27] Choi M, Song H, Kim M, et al.A Case of Baclofen-Associated Encephalopathy in a Maintenance Hemodialysis Patient[J].kidney research and clinical practice, 2004,23(2):353-357. [28] 黄雯, 石义霞,弓在春. 巴氯芬致尿毒症患者意识障碍[J].药物不良反应杂志,1999,11(1):40. [29] 杨君, 杨慧, 王曦, 等. 老年腹膜透析患者巴氯芬药物中毒催醒治疗与护理[J].护士进修杂志,2010, 25(24): 2295-2296 [30] 车伟伟,赵德龙. 巴氯芬致老年维持性血液透析患者轻度昏迷2例报告[J].基层医学论坛,2017, 21(19):2581. [31] Vlavonou R, Perreault MM, Barrière O, et al.Pharmacokinetic characterization of baclofen in patients with chronic kidney disease: dose adjustment recommendations[J].J Clin Pharmacol,2014,54(5):584-592.
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