Baclofen: Effective Muscle Spasticity Management
Baclofen
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Baclofen is a centrally acting skeletal muscle relaxant primarily indicated for the management of muscle spasticity. It functions as a gamma-aminobutyric acid (GABA) agonist, specifically targeting GABA-B receptors in the spinal cord to inhibit monosynaptic and polysynaptic reflexes. This pharmacological action reduces muscle tone and spasm frequency, offering significant symptomatic relief for patients with neurological conditions. Clinical use requires careful titration and monitoring to balance efficacy with tolerability.
Features
- Active ingredient: Baclofen
- Available formulations: Oral tablets, intrathecal solution
- Mechanism: GABA-B receptor agonist
- Half-life: 2.5–4 hours (oral)
- Bioavailability: Approximately 70–80%
- Protein binding: 30%
- Metabolism: Hepatic (minimal)
- Excretion: Primarily renal (70–80% unchanged)
Benefits
- Reduces frequency and intensity of muscle spasms
- Decreases muscle rigidity and improves voluntary movement
- Enhances functional capacity and mobility in spasticity patients
- May alleviate associated pain from muscle hypertonicity
- Intrathecal administration provides targeted therapy with reduced systemic effects
- Improves quality of life through better sleep and daily activity performance
Common use
Baclofen is principally prescribed for the symptomatic treatment of spasticity resulting from multiple sclerosis, spinal cord injuries, and other spinal cord diseases. It is also used off-label for conditions such as hiccups, trigeminal neuralgia, and alcohol withdrawal syndrome. The intrathecal formulation is reserved for severe spasticity in patients unresponsive to oral therapy or who experience intolerable side effects.
Dosage and direction
Oral administration: Initiate with 5 mg three times daily; may increase by 15 mg daily every 3 days. Maintenance dose typically ranges between 40–80 mg daily in divided doses. Maximum recommended dose is 80 mg daily.
Intrathecal administration: Requires implantation of a programmable pump. Initial screening dose: 50–100 mcg; titration is highly individualized based on response. Maintenance doses range from 12–2,000 mcg/day.
Administration should be consistent with regards to meals. Abrupt discontinuation must be avoided; taper gradually over 1–2 weeks.
Precautions
- Use cautiously in patients with renal impairment; dosage adjustment necessary
- Monitor for signs of sedation, especially when initiating therapy
- Assess psychiatric history; may exacerbate depression or psychosis
- Caution in elderly patients due to increased risk of CNS effects
- Evaluate seizure threshold in epileptic patients
- Regular ophthalmological exams recommended with long-term use
- Potential for dependency with prolonged high-dose use
Contraindications
- Hypersensitivity to baclofen or any component of the formulation
- Active peptic ulcer disease
- Severe renal impairment (CrCl <30 mL/min)
- Concurrent use with other CNS depressants without careful monitoring
- History of psychotic disorders (relative contraindication)
- Intrathecal administration contraindicated in infection at injection site or systemic infection
Possible side effect
- Common (>10%): Drowsiness, dizziness, weakness, nausea
- Less common (1–10%): Headache, insomnia, hypotension, constipation
- Rare (<1%): Hallucinations, seizures, respiratory depression, hepatic enzyme elevation
- Intrathecal-specific: Catheter-related complications, meningitis, pump malfunction
- Withdrawal symptoms: Hyperthermia, pruritus, rebound spasticity, rhabdomyolysis
Drug interaction
- CNS depressants: Enhanced sedation with alcohol, benzodiazepines, opioids
- Antihypertensives: Potentiated hypotensive effects
- MAO inhibitors: Risk of serotonin syndrome
- Levodopa: May exacerbate psychiatric symptoms
- Tricyclic antidepressants: Increased CNS depression
- Neuromuscular blocking agents: Prolonged paralysis risk
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule to avoid withdrawal symptoms. For intrathecal therapy, consult immediately with healthcare provider as missed doses may require pump reprogramming.
Overdose
Symptoms: Coma, respiratory depression, hypotonia, seizures, hypothermia.
Management: Supportive care including airway protection, ventilatory support, and IV fluids. Hemodialysis may be effective due to partial renal excretion. There is no specific antidote; physostigmine is not recommended. For intrathecal overdose, immediate pump reservoir aspiration may be necessary.
Storage
Store at controlled room temperature (20–25°C). Protect from light and moisture. Keep oral tablets in original container. Intrathecal solution must remain sterile; do not use if cloudy or particulate matter is present. Keep all medications out of reach of children and pets.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions. Dosage and administration must be determined by a physician familiar with the patient’s medical history. Off-label uses should be carefully evaluated for risk-benefit ratio.
Reviews
“Baclofen has significantly improved spasticity management in our MS patients, though careful titration is essential.” – Neurology Specialist
“Intrathecal baclofen therapy revolutionized treatment for severe spinal spasticity, despite technical challenges.” – Physical Medicine and Rehabilitation Physician
“While effective, the sedative effects require careful patient selection and monitoring.” – Clinical Pharmacist
“Oral baclofen remains a cornerstone therapy, though newer agents offer alternatives for intolerable side effects.” – Movement Disorder Specialist