Baclofen: Targeted Muscle Spasticity Relief for Enhanced Mobility
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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) derivative, specifically agonizing GABA-B receptors at the spinal cord level to inhibit monosynaptic and polysynaptic reflex transmission. This pharmacological action reduces muscle tone and spasm frequency, offering significant symptomatic relief for patients with neurological conditions. Its efficacy and tolerability profile make it a cornerstone in spasticity management protocols.
Features
- Active ingredient: Baclofen (GABA-B receptor agonist)
- Available formulations: Oral tablets (10mg, 20mg), intrathecal solution
- Mechanism: Acts presynaptically to inhibit the release of excitatory neurotransmitters
- Half-life: Approximately 2.5–4 hours
- Metabolism: Hepatic (minimal)
- Excretion: Primarily renal (70–80% unchanged)
Benefits
- Reduces painful muscle spasms and improves range of motion
- Decreases muscle rigidity and hyperreflexia in upper motor neuron disorders
- Enhances functional capacity for activities of daily living
- May improve bladder and bowel function in spinal cord injury patients
- Facilitates physiotherapy and rehabilitation efforts
- Offers intrathecal administration option for severe, refractory spasticity
Common use
Baclofen is principally prescribed for the symptomatic treatment of spasticity resulting from multiple sclerosis, spinal cord injuries, cerebral palsy, and other spinal cord diseases. It is particularly effective in managing flexor spasms, clonus, and associated pain. Off-label uses include management of hiccups, trigeminal neuralgia, and alcohol withdrawal syndrome, though evidence supporting these applications varies. The intrathecal formulation is reserved for severe spasticity in patients unresponsive to oral therapy or who experience intolerable side effects.
Dosage and direction
Initial adult dosing: 5mg orally three times daily, may increase by 5mg every three days to achieve desired effect.
Maintenance range: 40–80mg daily divided into 3–4 doses (maximum 80mg daily).
Geriatric dosing: Initiate at 5mg twice daily with slower titration.
Intrathecal administration: Requires implantation of a programmable pump with initial test dose of 50–100mcg; maintenance doses typically range from 300–800mcg daily.
Take with food or milk to minimize gastrointestinal upset. Do not crush or chew extended-release formulations. Abrupt discontinuation must be avoided due to risk of withdrawal syndrome.
Precautions
Monitor renal function periodically during therapy. Use caution in patients with psychiatric disorders, cerebrovascular disease, or epilepsy. May impair alertness and coordination; advise against operating machinery until response is known. Elderly patients demonstrate increased sensitivity to CNS effects. Pregnancy Category C: use only if potential benefit justifies potential risk. Excreted in breast milk; consider alternative feeding methods.
Contraindications
Hypersensitivity to baclofen or any component of formulation. Avoid in patients with skeletal muscle spasm due to rheumatic disorders. Not recommended for stroke recovery patients due to potential functional impairment. Contraindicated in intrathecal administration for intravenous use or in patients with infection at injection site.
Possible side effect
Common (≥1%): Drowsiness (10–63%), dizziness (5–15%), weakness (5–15%), fatigue (5–10%), nausea (4–12%)
Less common: Headache, insomnia, hypotension, constipation, urinary frequency
Serious: Hallucinations, seizures, respiratory depression, severe hypotension, hepatitis
Intrathecal-specific: Catheter-related complications, meningitis, pump malfunction
Drug interaction
CNS depressants: Enhanced sedation with alcohol, benzodiazepines, opioids
Antihypertensives: Potentiated hypotensive effects
MAO inhibitors: Increased CNS depression
Levodopa: May exacerbate psychiatric symptoms
Tricyclic antidepressants: Increased muscle relaxation effect
Monitor closely when co-administering with other GABA-ergic agents
Missed dose
If remembered within a few hours, take missed dose immediately. If close to next scheduled dose, skip missed dose and resume regular schedule. Do not double doses. For intrathecal therapy, contact healthcare provider immediately as missed doses may precipitate withdrawal.
Overdose
Symptoms: Coma, respiratory depression, hypotonia, seizures, hypothermia
Management: Secure airway, provide ventilatory support, administer IV fluids for hypotension. There is no specific antidote; hemodialysis may be effective due to low molecular weight and minimal protein binding. Contact poison control center immediately.
Storage
Store at 20–25°C (68–77°F). Protect from light and moisture. Keep intrathecal solution refrigerated at 2–8°C (36–46°F); may be stored at room temperature for up to 90 days. 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 with a qualified healthcare professional before starting or changing any medication regimen. Individual response to therapy may vary based on clinical status, comorbidities, and concomitant medications. Proper diagnosis and supervision are essential for safe and effective use.
Reviews
“Baclofen has been transformative for my MS-related spasticity. While initial drowsiness was significant, dose titration achieved optimal balance between efficacy and side effects.” - Neurology Specialist, 15 years experience
“Intrathecal baclofen therapy revolutionized care for our severe spinal injury patients. The precision dosing and reduced systemic side effects represent a major advancement in spasticity management.” - Physical Medicine Specialist
“Effective but requires careful monitoring. Withdrawal symptoms can be severe if discontinued abruptly. Always taper over at least 1-2 weeks.” - Clinical Pharmacist