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13 November, 2019 00:00 00 AM
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Common muscle relaxant could pose mental dangers for seniors

A commonly prescribed muscle relaxant known as baclofen can leave older kidney patients so disoriented that they land in the hospital, a new study warns. "It can present with acute stroke-like symptoms, even though it's not a stroke," said senior researcher Dr. Amit Garg, a professor of nephrology at Western University in Ontario, Canada. "It can present with dementia-like symptoms."

About 1 in 25 people with low kidney function prescribed high doses of baclofen wound up being admitted to a hospital for severe confusion, according to a study of nearly 16,000 older Canadians with chronic kidney disease. By comparison, only one in 500 kidney patients not prescribed baclofen wound up hospitalized for confusion. "There was a pretty marked difference in risk," Garg said, noting that these findings "highlight a potential risk associated with these drugs that hasn't been fully appreciated."

Other seniors might also face this risk, since kidney function often declines as people grow older, he added.

Baclofen is typically prescribed to people suffering muscle spasms, Garg said. Doctors hand out more than 8 million prescriptions of baclofen every year. It's sold under a number of different brand names, including Lioresal, Gablofen and Kemstro.

The drug leaves the body when the kidneys filter it out of a person's blood, Garg explained.

"If someone's kidney function isn't working very well, that means the drug is accumulating in the system," he said. Garg and other doctors had started noticing that kidney patients on baclofen sometimes became disoriented and dazed.

For example, nephrologist Dr. Holly Koncicki remembers some dialysis patients showing up with noticeably clouded mental capacity.

"Of those I can remember, they often presented with confusion or being very sleepy and lethargic," said Koncicki, of the Icahn School of Medicine at Mount Sinai, in New York City.

In the Canadian study, Garg and his colleagues combed the medical literature and found 30 prior case reports linking baclofen to hitches in brain function, so they decided to more closely study this potential problem. The researchers pulled health data on nearly 16,000 older Ontario residents with chronic kidney disease who had been prescribed baclofen between 2007 and 2018. The investigators compared those patients' hospitalisations for mental conditions against those from a group of almost 300,000 kidney patients who'd not been prescribed the drug.

Patients were at greatest risk of hospitalisation for confusion if their kidney function was very impaired -- 30% or less -- and they had been prescribed a high dose of baclofen, more than 20 milligrams (mg) per day.

But even patients with kidney function as high as 60% had an increased risk of confusion when prescribed high doses of baclofen, the findings showed. About 1 in 5 older adults live with kidney function of less than 60%. Kidney patients prescribed baclofen at 20 mg/day or higher had nearly 20 times the relative risk of being hospitalized for an altered mental state, compared with patients not taking the drug, the researchers found.

Doses lower than 20 mg/day were associated with a nearly sixfold increase in kidney patients' risk of hospitalization.

Koncicki, who was not involved with the study, said, "In our older patients with impaired kidney function, there should be cautious use of this medication."

    HealthDay

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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