Baclofen-Associated Fall Risk

Patient Populations at High Risk

• Elderly patients (≥65 years) are at the highest risk of falls due to baclofen, and typically cannot tolerate doses greater than 30-40 mg per day, according to Praxis Medical Insights guidelines 1
• The British Journal of Pharmacology guidelines recommend avoiding baclofen in patients with obstructive sleep apnea due to its potential to provoke upper airway collapse during sleep and induce central apneas by depressing respiratory drive 2

Clinical Management Recommendations

• The American College of Physicians recommends avoiding baclofen in dementia patients due to cognitive and safety concerns 3
• Praxis Medical Insights guidelines suggest using the lowest effective dose of baclofen, particularly in elderly patients, starting with 5 mg three times daily, and adjusting the timing of administration to allow peak sedative effects to occur before sleep 1
• Patients on multiple CNS depressants should be cautious of additive sedative effects, and concomitant use of opioids, benzodiazepines, alcohol, and other sedating medications should be eliminated or minimized, according to Praxis Medical Insights guidelines 1, 3