Muscle relaxant can risk severe confusion in seniors

Common muscle relaxants we think as relatively harmless can be risky if a person with kidney disease consumes it with a higher dosage finds a recent study.

A new study conducted by ICES Western, Western University and Lawson Health Research Institute and published online on JAMA network reveals that patients with kidney dysfunction who were prescribed a high dose of the drug baclofen, were more likely to be admitted to hospital for disorientation and confusion, than those who weren’t prescribed the drug.

Actually, Dr. Peter Blake, Professor at Schulich Medicine & Dentistry, Western University found that this drug commonly prescribed for muscle spasms and muscle pain precipitated the symptoms of severe confusion in person with chronic kidney disease. He says it is widely prescribed because it has not previously been associated with serious side-effects.

However, the elderly taking medication for heart disease must also take care as Antiarrhythmic drugs linked to increased risk of falling, fainting, injuring in adult according to another study.

Research methodology

It is a retrospective population-based cohort study conducted in Ontario, Canada between the years 2007 to 2018. For which researchers recruited 15 942 older adult participants age 66 years or more and with a complaint of kidney dysfunction known as chronic kidney disease (CKD).

The scientists were trying to find the effect of a muscle relaxant (baclofen) under two objective:

Primary objective: The primary objective was to compare the risk of encephalopathy in a patient with CKD who is newly prescribed with more than or equal to 20 mg baclofen per day vs less than 20 mg baclofen per day.

Secondary objective: They were also interested to compare the risk of encephalopathy in baclofen users vs nonusers.

For which all the participants were given an oral dose of baclofen in either one of the exposure:

1. Oral baclofen of greater than or equal to 20 mg per day.
2. Oral baclofen at less than 20 mg per day.

The outcome of the above dosage were predefined under primary outcome and secondary outcome based on which researchers made their conclusion.

Primary outcome: The primary outcome scientist was looking for was 30-day risk of hospital admission with encephalopathy with following symptoms:

1. Delirium,
2. Disorientation,
3. Transient alteration of awareness,
4. Transient cerebral ischemic attack, or unspecified dementia (unclear diagnosis of dementia).

Secondary outcome:

1. Secondary outcomes were hospitalization with delirium as the main diagnosis,
2. Hospitalization for any cause, and
3. All-cause mortality.

Also read: Blood pressure? bedtime medication is best finds study

Result

The primary outcome, hospitalization with encephalopathy, occurred in:

• 108 (1.11%) patients who started baclofen at greater than or equal to 20 mg per day.
• and in 26 (0.42%) who started baclofen at less than 20 mg per day.

In the secondary comparison with 284 263 nonusers, both groups of baclofen users had a higher risk of encephalopathy.

What it means for us

Research reveals that Among older patients with CKD who were newly prescribed baclofen, the 30-day incidence of encephalopathy was increased among those prescribed higher doses compared with lower doses.

If verified, these risks should be balanced against the benefits of baclofen use.

Source:

Muanda FT, Weir MA, Bathini L, et al. Association of Baclofen With Encephalopathy in Patients With Chronic Kidney Disease. JAMA. Published online November 09, 2019. doi:https://doi.org/10.1001/jama.2019.17725