Baclofen Safety in Rhabdomyolysis

Clinical Considerations

• Baclofen toxicity presents with neurotoxicity, such as drowsiness, dizziness, sedation, and altered mental status, and can be life-threatening in patients with rhabdomyolysis 1
• Central nervous system depression from baclofen can worsen the clinical picture in rhabdomyolysis patients who may already have altered mental status from electrolyte abnormalities, myoglobinemia, or uremia, although the exact mechanism is not fully understood 1
• Abrupt discontinuation of baclofen can cause potentially life-threatening withdrawal symptoms, including hallucinations, delirium, seizures, fever, tremors, tachycardia, and autonomic instability, highlighting the need for careful management 1
• The American Geriatrics Society suggests considering alternative muscle relaxants with less renal dependence, such as benzodiazepines, for muscle spasm management during rhabdomyolysis recovery, although these alternatives carry their own risks 3
• Non-pharmacological interventions, such as positioning, range of motion exercises, and stretching, should be prioritized when possible to minimize the risk of medication-related complications 2
• Baclofen may also worsen obstructive sleep apnea by promoting upper airway collapse, adding respiratory risk, and this should be taken into account when managing patients with rhabdomyolysis 1, 2
• Tapering baclofen slowly rather than stopping abruptly, even in the setting of renal dysfunction, can help avoid withdrawal complications, and this approach is recommended for patients who have been on chronic baclofen 1, 2