Baclofen Interactions & Polypharmacy
Interactions
As you now know, interactions are events that occur when two drugs meet.
Consequently, Baclofen might do something to the other drug; or the other drug might do something to Baclofen; or they may both mess about with each other.
Sometimes, the effects of one or both are rubbed out.
Sometimes the effects of one or both are exaggerated.
Sometimes something totally unexpected and bizarre, maybe even dangerous, happens.
Sounds awful, doesn't it?
So, here's the good news.
Over the last 70 years or so, Baclofen has proven to be a really friendly kind of medicine. It seems to get on with almost all of its colleagues, with few, if any, really major arguments.
To start with, the best way of thinking about this is as follows:
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if you are taking any medicines to reduce your blood pressure, then it will probably drop more if you add Baclofen;
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if you are taking any medicines to make you less anxious or more sleepy, they will probably have an increased effect if you add Baclofen;
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some drugs enhance or reduce the relaxing effects of Baclofen;
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some drugs when added to Baclofen might do nasty things;
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some drugs might reduce the ability of your body to either break down or get rid of Baclofen so that its effects might last longer or be enhanced.
So, in a little detail
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Drugs generally used to reduce your blood pressure. If you add Baclofen, it will generally reduce your blood pressure even more |
ACE Inhibitors, alpha- and beta-blockers, angiotensin II receptor antagonists, calcium channle blockers, clonidine, diazoxide, diuretics, hydralazine, methyldops, minoxidil, mixonidine, nitrates, sodium nitropruside |
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If you take medicines to help you relax, then generally adding Baclofen will make you even more sleepy |
Anxiolytics, hypnotics, especially benzodiazepines |
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The muscle relaxing effects of Baclofen could be increased by |
Lithium, Propranolol, Tricyclic antidepressants.
Hyperkinesis is a rare side effect of Lithium. It can be increased by Baclofen |
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Agitation, confusion and hallucinations |
Levodopa |
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Reduced excretion of Baclofen, with potentially increased toxicity |
Non-steroidal anti-inflammatory drugs NSAIDs |
If you notice any other interactions with other medicines that you might be taking, please report them to me here.
Polypharmacy
The following definition is taken from Wikipedia
“The term polypharmacy generally refers to the use of multiple medications by a patient. The term is used when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take (pill burden). Furthermore, a portion of the treatments may not be evidence-based. The most common results of polypharmacy are increased adverse drug reactions, drug-drug interactions and higher costs. Polypharmacy is most common in the elderly but is also widespread in the general population.”
This is an issue very dear to my heart.
In a previous life, polypharmacy was one of my hobby-horses. Most surgeons find that the average age of their patients is getting higher and higher. One of my colleagues jokes that he is now a “Geriatric Surgeon”, rather than a General Surgeon. Many of these patients come into hospital with almost suitcases of medications that they are taking at home. When questioned properly about their symptoms and medications (which I always did, but which few others seem to), the following pattern was oft repeated –
“When I was at the hospital, Dr Clever (my consultant) gave me drug A. Then I got symptom Z. I went to my GP, Dr Smith, who gave me drug B. That gave me symptom Y. So, I went back to the surgery, and saw a different GP, Dr Jones. He prescribed drug C. But that only gave me symptom X. When I went back to the hospital, I saw a junior doctor, can’t remember his name, nice man though, who ordered some X-Rays. They were normal, so he gave me drug D. That made me develop Horrid Syndrome, which apparently occurs if you take drug D with drug B. When I finally saw Dr Clever again, he stopped drugs B, C and D, and just reduced the dose of drug A, and apologised to me for the unnecessary X-Rays. I’m fine now.”
I think that that messy paragraph describes the point perfectly. But what is the real point here? Why am I bringing it up now?
The vitally important point is that with high dose (often very high dose) Baclofen being taken by such large numbers of us, we are in somewhat uncharted territory. Further, many of us also:
• Are self diagnosing, self-prescribing, self-dispensing, and self-monitoring
• Are taking other anti-alcoholism medications alongside Baclofen. Many of these are extremely potent 'brain chemistry' altering medicines
• Have other psychological, if not psychiatric, problems for which we may be prescribed powerful “brain chemistry altering” medications
• Are on other medications for other unrelated medical conditions
• Are not eating properly
• Are not sleeping properly
have social stresses that overwhelm them
• Are, perhaps most importantly, still drinking often large amounts of alcohol
• And keeping the fact that we are taking high dose Baclofen secret from our doctors looking after all the other stuff
Consequently, we are each of us potentially concocting our own version of Baclofenestrone Soup, each with its own distinct recipe and unique effects. A recipe previously unknown within the annals of medical / pharmaceutical cookery. So individual to you that you may be first to add it to the books. God help you.
Worse, if any of us get down, fed up, depressed, pissed off, we often have a bathroom or medicine cabinet crammed to the gills with "I can easily kill myself" drugs. Each one makes taking the next so much easier as it drops your defences. You fall into a funnel of self-destruction.
This is very very dangerous indeed. If you don't need or take it, throw it out.
I’m not scare-mongering; I am merely highlighting an important issue, and asking you all to be very careful.
I hope that made sense.
Take care of yourselves.
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