Short-Term Use of Baclofen Leading to Delirium in a Patient With End Stage Renal Disease Receiving Hemodialysis

Baclofen, a muscle relaxant is primarily excreted by the kidneys. We present the case of a 60-year-old male who developed acute delirium, visual hallucinations, and behavioral changes after he took a friend’s prescription of baclofen for pain relief. There was immediate improvement after dialysis, and multiple sessions of hemodialysis led to complete resolution of symptoms. A high suspicion for pharmacological causes of delirium is needed in the end stage renal disease (ESRD). Baclofen is known but under recognized cause of acute delirium in ESRD patients. We discuss the pharmacokinetics of baclofen. We suggest reducing dose or preferably avoiding use of baclofen in ESRD patients, especially the elderly.