From the Guidelines
Baclofen 20 mg should be used with caution in patients with low blood pressure, especially when combined with tizanidine (Tinaziden) at night, due to the potential risk of exacerbating hypotension. According to the guidelines for the management of adult stroke rehabilitation care 1, oral baclofen can be considered for spasticity resulting in pain, poor skin hygiene, or decreased function. However, it is crucial to consider the potential effects of baclofen on blood pressure, particularly when used in conjunction with other medications like tizanidine that may also lower blood pressure.
When initiating baclofen in patients with low blood pressure, it is recommended to:
- Start with lower doses, such as 5-10 mg, and gradually increase as needed and tolerated
- Monitor blood pressure regularly to assess the patient's response to the medication
- Stagger the timing of baclofen and tizanidine to avoid peak effects occurring simultaneously
- Advise patients to change positions slowly, stay well-hydrated, and report any symptoms of hypotension, such as lightheadedness or increased weakness
The mechanisms of action of both baclofen and tizanidine contribute to their potential to reduce blood pressure. Baclofen activates GABA-B receptors in the spinal cord, while tizanidine is an alpha-2 adrenergic agonist. Given the potential risks, careful consideration and monitoring are necessary when using these medications in patients with low blood pressure.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Baclofen and Tizanidine Interaction
- Baclofen is a muscle relaxant used to treat muscle spasms, while Tizanidine is also a muscle relaxant used to treat muscle spasms caused by conditions such as multiple sclerosis or spinal injury 2.
- There is no direct evidence on the interaction between baclofen 20 mg and Tizanidine in patients with low blood pressure.
Hypotension Risk
- Tizanidine can lower blood pressure, and its use with other medications that affect blood pressure may increase the risk of hypotension 3.
- A study found that the use of Tizanidine with strong CYP1A2 inhibitors increased the risk of severe hypotension, defined as systolic blood pressure ≤ 70 mmHg 3.
- Baclofen has also been associated with hypotension, particularly in older adults, and its use should be cautious in patients with low blood pressure 4.
Treatment of Hypertension
- The treatment of hypertension typically involves lifestyle modifications, such as weight loss, healthy dietary patterns, physical activity, and moderation of alcohol consumption, as well as the use of antihypertensive medications 5.
- However, in patients with low blood pressure, the use of antihypertensive medications may need to be adjusted to avoid exacerbating hypotension.
Use of Baclofen and Tizanidine in Patients with Low Blood Pressure
- There is limited evidence on the use of baclofen and Tizanidine in patients with low blood pressure, and caution should be exercised when prescribing these medications to patients with hypotension 4, 2.
- Patients with low blood pressure should be closely monitored for signs of hypotension, such as dizziness, lightheadedness, and fainting, when taking baclofen and Tizanidine.