From the Guidelines
Baclofen is primarily used to treat muscle spasticity associated with conditions like multiple sclerosis, spinal cord injuries, and cerebral palsy, with a recommended starting dose of 5 mg three times daily, gradually increasing to an effective dose, usually between 40-80 mg per day divided into three or four doses, with a maximum recommended dose of 80 mg daily 1. The use of baclofen for spasticity is supported by guidelines from the American Heart Association/American Stroke Association, which recommend oral antispasticity agents, including baclofen, for generalized spastic dystonia, but note that they may result in dose-limiting sedation or other side effects 1. Some key points to consider when using baclofen include:
- Baclofen works by activating GABA-B receptors in the spinal cord, which inhibits the release of excitatory neurotransmitters and reduces muscle tone and involuntary muscle contractions 1.
- Common side effects include drowsiness, dizziness, weakness, and fatigue, which often improve with continued use 1.
- Patients should avoid abruptly stopping baclofen as this can cause withdrawal symptoms including hallucinations, seizures, and increased spasticity 1.
- Baclofen should be used cautiously in elderly patients and those with kidney impairment, and dosage adjustments may be necessary 1.
- For severe spasticity unresponsive to oral baclofen, intrathecal baclofen therapy delivered via an implanted pump directly to the spinal fluid may be considered for more targeted relief with fewer systemic side effects 1. In terms of specific patient populations, the guidelines recommend considering intrathecal baclofen therapy as early as 3 to 6 months after stroke for patients refractory to other treatments 1. Overall, the use of baclofen for spasticity should be individualized and based on a thorough assessment of the patient's condition and response to treatment.
From the FDA Drug Label
Indications and Usage Baclofen tablets are useful for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. Patients should have reversible spasticity so that baclofen tablets treatment will aid in restoring residual function. Baclofen tablets may also be of some value in patients with spinal cord injuries and other spinal cord diseases.
The primary use of Baclofen is for the alleviation of spasticity resulting from:
- Multiple sclerosis
- Spinal cord injuries
- Other spinal cord diseases It is used to relieve flexor spasms, concomitant pain, clonus, and muscular rigidity in patients with reversible spasticity 2.
From the Research
Use of Baclofen
Baclofen is a muscle relaxant and antispasticity drug used to treat spasticity, a motor disorder characterized by tight or stiff muscles that may interfere with voluntary muscle movements 3. It is commonly used to treat patients with multiple sclerosis (MS), spinal cord injury (SCI), cerebral palsy (CP), and acquired brain injury (ABI) 3, 4.
Mechanism of Action
Baclofen acts as a GABA receptor agonist, inhibiting spinal synaptic reflexes and reducing spasticity and spasms 5. It can be administered orally or intrathecally, with the latter method allowing for direct delivery to the cerebrospinal fluid (CSF) and minimizing central side effects 3, 4.
Indications
Baclofen is indicated for use in patients with spasticity of spinal origin unresponsive to treatment with maximum doses of oral baclofen, tizanidine, and/or dantrolene 4. It is also used to treat severe spasticity in patients with spinal cord injury, spinal cord disease, and multiple sclerosis 5.
Benefits
The benefits of baclofen include:
- Reduction of spasticity and spasms 3, 4, 5
- Improvement in functioning and patient perception of quality of life 5
- Ease of caretaking 5
- Cost-effectiveness due to reduction in required hospitalizations and medical care for conditions resulting from spasticity 5
Side Effects
Common side effects of baclofen include:
- Sedation or somnolence 3, 4, 6
- Excessive weakness 3, 4
- Dizziness or vertigo 3, 4
- Psychological disturbances 4
- Nausea and vomiting 6
Administration
Baclofen can be administered orally or intrathecally via a surgically implanted pump and reservoir 3, 4, 5, 7. The intrathecal method allows for precise dose titration and adjustment over a 24-hour period for maximum effectiveness 5.