Baclofen Uses in Clinical Practice
Baclofen is primarily used for the treatment of spasticity resulting from multiple sclerosis, spinal cord injuries, and other spinal cord diseases, particularly for relieving flexor spasms, pain, clonus, and muscular rigidity. 1
Primary FDA-Approved Indications
- Baclofen is indicated for alleviating signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms, concomitant pain, clonus, and muscular rigidity 1
- It is also valuable in patients with spinal cord injuries and other spinal cord diseases where reversible spasticity is present 1, 2
- In open-label studies, oral baclofen improved spasticity in 70-87% of patients and reduced spasms in 75-96% of patients with spinal origin spasticity 2
Administration Routes
- Oral baclofen is the first-line approach for spasticity management 2
- Intrathecal baclofen is indicated for patients with spasticity of spinal origin who are unresponsive to maximum doses of oral baclofen, tizanidine, and/or dantrolene 2
- Intrathecal administration has shown >80% improvement in muscle tone and >65% improvement in spasms in patients with severe spasticity 2, 3
Important Non-FDA Approved Uses
- Baclofen has been studied for alcohol abstinence maintenance in patients with alcoholic liver disease, showing effectiveness in reducing alcohol craving in patients with liver cirrhosis 4
- It has been investigated for use in stroke-related spasticity, though with limited evidence of functional gains 4
- Intrathecal baclofen has demonstrated efficacy in reducing spasticity in chronic stroke patients 4
Conditions Where Baclofen is NOT Recommended
- Baclofen is not indicated for treating skeletal muscle spasm resulting from rheumatic disorders 1
- The FDA label specifically states that efficacy has not been established in stroke, cerebral palsy, and Parkinson's disease, and therefore is not recommended for these conditions 1
- In Parkinson's disease, muscle dysfunction typically involves different pathophysiological mechanisms than the spasticity seen in multiple sclerosis or spinal cord injury 5
Safety Considerations and Adverse Effects
- Common adverse effects include sedation, somnolence, excessive weakness, vertigo, and psychological disturbances, with incidence ranging from 10% to 75% 2
- Most adverse effects are dose-related, transient, and/or reversible 2
- Baclofen may worsen obstructive sleep apnea by promoting upper airway collapse during sleep, which is particularly concerning in patients with pre-existing sleep disorders 5, 6
- Abrupt discontinuation can lead to serious withdrawal symptoms including hallucinations, seizures, psychic symptoms, and hyperthermia 2, 7, 8
- Patients should be withdrawn slowly from baclofen before surgery to prevent withdrawal symptoms 7
- Use with caution in patients with renal disease as it may carry an unnecessarily high risk 2
Comparison with Other Antispasticity Medications
- Tizanidine has similar efficacy to baclofen but with better tolerability, particularly with less weakness 2
- Unlike other skeletal muscle relaxants such as carisoprodol (risk of abuse), dantrolene (risk of hepatotoxicity), and tizanidine (risk of hepatotoxicity), baclofen has a different safety profile but still requires careful monitoring 4
- For stroke patients, targeted botulinum toxin injections may be preferred for focal spasticity 5
Baclofen should be used cautiously, with appropriate patient selection and monitoring for adverse effects, particularly when initiating therapy or adjusting dosages. The benefit-risk assessment is generally favorable for patients with spinal spasticity when used appropriately 2.