Baclofen: 7 things you should know

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Medically reviewed by Carmen Pope, BPharm. Last updated on March 31, 2023.

1. How it works

• Baclofen may be used as a muscle relaxant.
• Experts are not sure exactly how baclofen works to relieve muscle spasms but research suggests it inhibits nerve impulses in the spine, which relaxes and relieves muscle contractions.
• Baclofen belongs to the class of medicines known as skeletal muscle relaxants.

2. Upsides

• Baclofen is used to relieve muscle spasms such as those caused by multiple sclerosis or spinal cord injuries due to damage or disease.
• Particularly effective for relieving flexor spasms (involuntary muscle spasms involving the ankle, knee, or hip) and the pain, contractions, and rigidity associated with these.
• May help restore some muscle function.
• Baclofen is not effective for muscle spasms caused by rheumatoid arthritis, cerebral palsy, stroke, or Parkinson’s disease.
• May also be used off-label to treat other conditions such as hiccups or Tourette’s syndrome.
• Generic baclofen is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Drowsiness, dizziness, or sedation, that may affect your ability to drive or operate machinery or perform other hazardous tasks. The sedative effect of baclofen may be enhanced by alcohol or by other medications that also cause sedation (such as benzodiazepines and opiates).
• Weakness, fatigue, insomnia, nausea, constipation, low blood pressure, headache, and confusion have also been reported.
• Sudden discontinuation of baclofen has been associated with hallucinations and seizures. Baclofen should be withdrawn slowly unless it is an emergency.
• May not be suitable for some people, including those with a history of stroke or who rely on spasticity to maintain an upright position, balance, or for increased function. The dosage of baclofen should be reduced in those with kidney disease.
• People with a history of seizures or epilepsy should be monitored regularly for changes in seizure control or EEG recordings.
• Neonatal withdrawal symptoms, such as increased muscle tone, tremors, jitteriness, or seizures have been reported starting hours to days after delivery in neonates whose mothers were treated with oral baclofen throughout pregnancy. If the potential benefit of using baclofen during pregnancy justifies the potential risk to the fetus then gradually reduce the dose and discontinue baclofen before delivery. Baclofen appears in low levels in milk but is not expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor newborn infants for signs of sedation.
• May cause an increase in the risk of ovarian cysts.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

Baclofen relieves muscle spasms associated with multiple sclerosis and spinal cord injury or disease, but its use is limited by its ability to cause sedation and increase seizure risk.

5. Tips

• Baclofen may be taken with or without food.
• Treatment should be started at a low dose and increased gradually as directed by your doctor. Take baclofen as directed by your doctor. Do not take more than is recommended.
• Do not drive or operate machinery, or perform hazardous tasks if baclofen makes you drowsy, dizzy, or sleepy.
• Avoid alcohol while you are taking baclofen.
• Do not stop taking this medicine suddenly. If you feel you are not gaining any benefit from this drug, or the side effects are intolerable, talk with your doctor about slowly discontinuing it.
• Tell your doctor if you are pregnant, intending to become pregnant, or breastfeeding because baclofen may not be suitable for you.

6.

Response and effectiveness

• Baclofen is rapidly absorbed, although absorption may be reduced with higher dosages. There is a wide variation in the way individuals respond to baclofen, with some people reporting a reduction in symptoms of muscle spasm within a few hours, whereas for some others it may take several weeks.

7. Interactions

Medicines that interact with baclofen may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with baclofen. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with baclofen include:

• anti-anxiety medications
• anticonvulsants
• antidepressants, such as amitriptyline, imipramine, nortriptyline, and monoamine oxidase inhibitors
• antihistamines that cause sedation, such as diphenhydramine
• opioid analgesics such as oxycodone and morphine
• other muscle relaxants such as cyclobenzaprine
• sleeping pills
• some medications used to treat mental illness, such as clozapine and thioridazine.

Alcohol may worsen the side effects of baclofen such as drowsiness and dizziness.

Note that this list is not all-inclusive and includes only common medications that may interact with baclofen. You should refer to the prescribing information for baclofen for a complete list of interactions.

More about baclofen

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• Dosage information
• During pregnancy
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Patient resources

• Drug Information
• Baclofen (Intrathecal) (Advanced Reading)
• Baclofen (Oral) (Advanced Reading)
• Baclofen Intrathecal Injection
• Baclofen Tablets
• Baclofen Oral Solution

Other brands

Lioresal, Gablofen, Fleqsuvy, Lyvispah, Ozobax

Professional resources

• Prescribing Information

Related treatment guides

• Alcohol Withdrawal
• Cervical Dystonia
• Chronic Spasticity
• Cerebral Spasticity

References

• Baclofen. Revised 03/2023. Chartwell RX, LLC https://www.drugs.com/pro/baclofen.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use baclofen only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2023 Drugs.com. Revision date: March 30, 2023.

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</p> ”> Prescription only Baclofen relieves muscle spasms associated with multiple sclerosis and spinal cord injury or disease, but its use is limited by its ability to cause sedation and increase seizure risk. Prescribed for… View more	Side effects are rare, but strenuous activity should be avoided immediately after each appointment.</p> <p> Prescribed for Cervical Dystonia, Chronic Migraine, Blepharospasm, Chronic Spasticity, Facial Wrinkles, Dystonia, Hyperhidrosis, Lower Limb Spasticity, Migraine, Migraine Prevention, Neurogenic Bladder, Neurogenic Detrusor Overactivity, Overactive Bladder, Strabismus, Upper Limb Spasticity, Urinary Frequency, Urinary Incontinence. </p> <p> Botox may also be used for purposes not listed in this comparison guide. </p> ”> Prescription only Botox is approved to treat many conditions, such as chronic migraine, involuntary muscle contractions or twitching, excessive sweating, increased saliva, and overactive bladder to name a few. Botox… View more	Prescription only Prescribed for Migraine Prevention, Chronic Migraine. Qulipta may also be used for purposes not listed in this medication guide.	Related suggestions Migraine Prevention (Migraine Prophylaxis) Topamax Topiramate Propranolol Amitriptyline Nurtec ODT OnabotulinumtoxinA Popular comparisons Baclofen vs cyclobenzaprine Baclofen vs Flexeril Baclofen vs Botox Baclofen vs chlorpromazine Baclofen vs chlordiazepoxide Baclofen vs Austedo
More about Baclofen	More about Botox (onabotulinumtoxinA)	More about Qulipta (atogepant)
Generic Status
Lower-cost generic is available	No lower-cost generic available	No lower-cost generic available
Ratings & Reviews
Baclofen has an average rating of 6. 9 out of 10 from a total of 426 ratings on Drugs.com. 61% of reviewers reported a positive effect, while 24% reported a negative effect.	Botox has an average rating of 5.5 out of 10 from a total of 450 ratings on Drugs.com. 45% of reviewers reported a positive effect, while 44% reported a negative effect.	Qulipta has an average rating of 6.7 out of 10 from a total of 61 ratings on Drugs.com. 55% of reviewers reported a positive effect, while 22% reported a negative effect.
View all 426 reviews	View all 450 reviews	View all 61 reviews
Drug Class
Skeletal muscle relaxants	Skeletal muscle relaxants	CGRP inhibitors
Side Effects
Commonly reported side effects include: drowsiness See also: baclofen side effects in more detail.	Common side effects include: antibody development See also: Botox side effects in more detail.	See also: Qulipta side effects in more detail.
Pricing and Coupons * Prices are without insurance
We could not find an exact match for this medicine. Try searching the Price Guide directly.	Quantity 1 powder for injection Dosage 100 units Per Unit* $677.10 Cost* $677.10 View all Botox prices	Quantity 30 tablet Dosage 10 mg Per Unit* $36. 84 Cost* $1,105.20 View all Qulipta prices
Get free Discount Card	Get free Discount Card	Get free Discount Card
Dosage Form(s) Available
Intrathecal solution Oral liquid Oral tablet	Injectable powder for injection	Oral tablet
Half Life The half-life of a drug is the time taken for the plasma concentration of a drug to reduce to half its original value.
6.8 hours	N/A	11 hours
CSA Schedule ** View glossary of terms
Is not subject to the Controlled Substances Act.	Is not subject to the Controlled Substances Act.	Is not subject to the Controlled Substances Act.
Pregnancy Category
See the full pregnancy warnings document.	See the full pregnancy warnings document.	Summary unavailable. See the full pregnancy warnings document.
Drug Interactions
A total of 360 drugs are known to interact with baclofen: 26 major drug interactions (144 brand and generic names) 333 moderate drug interactions (1316 brand and generic names) 1 minor drug interactions (2 brand and generic names)	A total of 114 drugs are known to interact with Botox: 24 major drug interactions (57 brand and generic names) 90 moderate drug interactions (540 brand and generic names)	A total of 172 drugs are known to interact with Qulipta: 77 major drug interactions (215 brand and generic names) 9 moderate drug interactions (18 brand and generic names) 86 minor drug interactions (270 brand and generic names)
Alcohol/Food/Lifestyle Interactions
Alcohol can increase the nervous system side effects of baclofen such as dizziness, drowsiness, and. .. View more	No known alcohol/food interactions. This does not necessarily mean no interactions exist. Always consult your healthcare provider.	No known alcohol/food interactions. This does not necessarily mean no interactions exist. Always consult your healthcare provider.
Disease Interactions
Renal dysfunction Autonomic dysreflexia Psychoses Seizure disorders	Dysphagia/respiratory/neuromuscular disorders Infection UTI	Hepatic impairment
First Approval Date
November 22, 1977	December 09, 1991	September 28, 2021
WADA Class View World Anti-Doping Agency classifications.
N/A	N/A	N/A
More Information
Side effects Pregnancy warnings Breastfeeding warnings Dosage information Drug images Drug interactions Support group	Side effects Pregnancy warnings Breastfeeding warnings Dosage information Drug images Drug interactions Support group Pricing and coupons En Español	Side effects Pregnancy warnings Breastfeeding warnings Dosage information Drug images Drug interactions Support group Pricing and coupons En Español
Patient resources
Overview Advanced reading	Overview	Overview Advanced reading
Professional Resources
Monograph (AHFS) Prescribing information	Prescribing information	Prescribing information

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The choice of pharmacological therapy for spastic muscle hypertonicity | #02/13

The main drugs used to reduce muscle tone are muscle relaxants. According to the mechanism of action, muscle relaxants of central action (affect the synaptic transmission of excitation in the central nervous system) and peripheral action (inhibit direct excitability of striated muscles) are distinguished. When using muscle relaxants, quite significant side effects can occur, which should be carefully evaluated when choosing a drug [1, 2].

When choosing antispastic drugs, their ability to inhibit polysynaptic reflexes (reduction of spasticity) is taken into account, while having the least effect on monosynaptic reflexes (muscle strength). An antispastic drug should reduce muscle spasticity with minimal loss of muscle strength [3, 4].

Drug therapy is based on the use of tablet and injection forms. Oral antispastic agents, by reducing muscle tone, can improve motor functions, facilitate care for an immobilized patient, relieve painful muscle spasms, enhance the effect of physiotherapy exercises, and prevent the development of contractures [5]. With a mild degree of spasticity, the use of muscle relaxants can lead to a significant positive effect, however, with severe spasticity, large doses of muscle relaxants may be required, the use of which often causes undesirable side effects. Treatment with muscle relaxants begins with a minimum dose, then it is slowly increased to achieve the effect [6].

The centrally acting muscle relaxants most commonly used in Russia for the treatment of spastic muscle hypertonicity include baclofen, tizanidine, tolperisone, and diazepam [7, 8].

Baclofen (Baclosan, Lioresal) has an antispastic effect mainly at the spinal level. The drug is an analogue of gamma-aminobutyric acid (GABA), which binds to presynaptic GABA receptors, leading to a decrease in the release of excitatory amino acids (glutamate, aspartate) and suppression of mono- and polysynaptic activity at the spinal level, which causes a decrease in spasticity. The drug also exhibits a moderate central analgesic effect. Baclofen is used for spinal and cerebral spastic muscle hypertonicity of various origins. The initial dose is 5-15 mg / day (in one or three doses), then the dose is increased by 5 mg every day until the desired effect is obtained. The drug is taken with food. The maximum dose of baclofen for adults is 60–75 mg/day. Side effects are more often manifested by sedation, drowsiness, decreased concentration, dizziness and often weaken during treatment. Perhaps the occurrence of nausea, constipation and diarrhea, arterial hypertension, increased ataxia, the appearance of paresthesia. Caution is required in the treatment of elderly patients, stroke patients, patients with gastric and duodenal ulcers. Baclofen is contraindicated in epilepsy, a history of seizures [9, 10].

With severe spasticity, when the usual oral administration of antispastic drugs is not effective, intrathecal administration of baclofen is indicated, which was first proposed in 1984 by R. Penn. To achieve the required concentration of the drug in the cerebrospinal fluid, it is necessary to take quite significant doses of baclofen, which can lead to impaired consciousness, drowsiness, and weakness. In this regard, systems have been developed in which baclofen is delivered directly to the intrathecal space of the spinal cord using an intrathecal baclofen pumping system. At the same time, the clinical effect is achieved with much lower doses of baclofen than when using tablet forms [11, 12].

This system consists of a reservoir containing baclofen or a similar drug, a pump (pump), with which the drug is dosed into the intrathecal space of the spinal cord through a lumbar catheter, and a power supply unit. From the reservoir, baclofen enters directly into the cerebrospinal fluid, and its dosage is controlled by a special radio telemetry device. The amount of drug entering the cerebrospinal fluid can be changed depending on the clinical picture. Baclofen is added to the reservoir after 2–3 months by percutaneous puncture [13].

The use of a baclofen pump improves the speed and quality of walking in patients with non-fixed reflex contractures due to high spasticity of synergistic muscles and imbalance of antagonist muscles. The available 15-year clinical experience of using baclofen intrathecally in stroke patients indicates the high efficiency of this method in reducing not only the degree of spasticity, but also pain syndromes and dystonic disorders. A positive effect of a baclofen pump on the quality of life of stroke patients has been noted [14].

Tizanidine (Sirdalud) is a centrally acting muscle relaxant, an alpha-2-adrenergic receptor agonist. The drug reduces spasticity due to the suppression of polysynaptic reflexes at the level of the spinal cord, which may be caused by inhibition of the release of excitatory amino acids L-glutamate and L-aspartate and activation of glycine, which reduces the excitability of spinal cord interneurons. Tizanidine also has a moderate central analgesic effect. The drug is effective for cerebral and spinal spasticity, as well as for painful muscle spasms. The initial dose of the drug is 2-6 mg / day in one or three divided doses, with individual selection, the dose is increased by 2 mg by 3-4 days. When taken orally, the effect of the drug appears after 30-45 minutes, the maximum effect occurs within 1-2 hours. The average therapeutic dose is 12-24 mg/day, the maximum dose is 36 mg/day. As side effects, drowsiness, dry mouth, dizziness and a decrease in blood pressure may occur, which limits the use of the drug in post-stroke spasticity. The antispastic effect of tizanidine is comparable to the effect of baclofen, however, tizanidine, with an adequate dosage selection, is better tolerated, since it does not cause general muscle weakness and does not increase muscle weakness in the paralyzed limb [15, 16].

Tolperisone (Mydocalm) is an antispastic drug of central action, it depresses the caudal part of the reticular formation and has N-anticholinergic properties. Tolperisone reduces the activity of spinal neurons involved in the formation of spasticity by limiting the flow of sodium through the membrane of nerve cells. The most commonly used dose is 300–450 mg/day in two or three divided doses. A decrease in muscle tone when prescribing tolperisone is sometimes accompanied by a vasodilating effect, which should be taken into account when prescribing to patients with a tendency to arterial hypotension. Also, the drug can cause or increase urinary incontinence in patients [17].

The main side effect of baclofen, tizanidine and tolperisone is the rapid onset of muscle weakness, and in each case the doctor must find a balance between a decrease in tone and an increase in weakness. The balance curve between a decrease in spastic tone and an increase in muscle weakness in patients with an increase in the dose of Mydocalm, Sirdalud or Baclofen shows that the most rapid increase in weakness occurs when taking Baclofen, and the mildest drug that allows you to effectively select an individual dosage is Mydocalm. In all cases, given the presence of a narrow therapeutic window, the course of treatment begins with a small dose of the drug, gradually increasing it until a distinct antispastic effect is achieved, but not until weakness appears [18, 19].

Diazepam (Realanium, Relium, Sibazon) is a muscle relaxant because it has the ability to stimulate reduced presynaptic inhibition at the spinal level. It has no direct GABA-ergic properties, increases the concentration of acetylcholine in the brain and inhibits the reuptake of norepinephrine and dopamine in synapses. This leads to an increase in presynaptic inhibition and is manifested by a decrease in stretch resistance, an increase in the range of motion. Diazepam also has the ability to reduce pain caused by muscle spasm. Along with a decrease in muscle tone, lethargy, dizziness, impaired attention and coordination develop due to toxic effects on the central nervous system. This significantly limits the use of diazepam as a muscle relaxant. It is used mainly for the treatment of spasticity of spinal origin, if necessary, a short-term decrease in muscle tone. For the treatment of spasticity, it is prescribed at a dose of 5 mg once or 2 mg 2 times a day. The maximum daily dose may be 60 mg. At high doses, there may be disturbances in consciousness, transient liver dysfunction and blood changes. The duration of treatment is limited due to the possible development of drug dependence [20].

Clonazepam is a benzodiazepine derivative. Clonazepam has a sedative, central muscle relaxant, anxiolytic effect. The muscle relaxant effect is achieved by enhancing the inhibitory effect of GABA on the transmission of nerve impulses, stimulating benzodiazepine receptors located in the allosteric center of the postsynaptic GABA receptors of the ascending activating reticular formation of the brainstem and intercalary neurons of the lateral horns of the spinal cord, as well as reducing the excitability of the subcortical structures of the brain and inhibition of polysynaptic spinal reflexes.

The rapid onset of drowsiness, dizziness and addiction limits the use of this drug. To reduce the manifestation of possible adverse reactions, it is necessary to reach a therapeutic dose by slow titration over two weeks. For oral administration, adults are recommended an initial dose of not more than 1 mg / day. Maintenance dose – 4-8 mg / day. Perhaps the appointment of small doses in combination with other muscle relaxants. Clonazepam is effective in paroxysmal increases in muscle tone. Contraindicated in acute diseases of the liver, kidneys, myasthenia gravis [21].

Dipotassium clorazepate (Tranxen) is an analogue of benzodiazepine, is transformed into the main metabolite of diazepam, has a greater activity and duration of antispastic action than diazepam. Its good effect was noted in the treatment in the form of a decrease in phasic stretch reflexes, it has a slight sedative effect. The initial dose is 5 mg 4 times a day, then reduced to 5 mg 2 times a day [22].

Dantrolene is an imidazoline derivative that acts outside the central nervous system, mainly at the level of muscle fibers. The mechanism of action of dantrolene is blocking the release of calcium from the sarcoplasmic reticulum, which leads to a decrease in the degree of contractility of skeletal muscles, a reduction in muscle tone and phasic reflexes, and an increase in the range of passive movements. An important advantage of dantrolene in relation to other muscle relaxants is its proven effectiveness in relation to spasticity not only of spinal, but also of cerebral origin. The initial dose is 25 mg / day, if tolerated, the dose is increased within 4 weeks to 400 mg / day. Side effects – drowsiness, dizziness, nausea, diarrhea, decreased glomerular filtration rate. A serious danger, especially in elderly patients at a dose of more than 200 mg / day, is a hepatotoxic effect, therefore, during the treatment period, liver function should be regularly monitored. Elimination of dantrolene by 50% is carried out due to hepatic metabolism, in this regard, it is contraindicated in liver diseases. Caution should also be observed in severe heart or lung diseases.

Katapresan – is used mainly for spinal injuries, acts on alpha-2-agonists of the brain, has presynaptic inhibition. Side effects include lowering blood pressure and depression. The initial dose is 0.05 mg 2 times a day, the maximum is 0.1 mg 4 times a day.

Temazepam interacts with benzodiazepine receptors of the allosteric center of postsynaptic GABA receptors located in the limbic system, ascending activating reticular formation, hippocampus, intercalary neurons of the lateral horns of the spinal cord. As a result, channels are opened for the incoming currents of chloride ions and thus the action of the endogenous inhibitory mediator, GABA, is potentiated. The recommended dose is 10 mg 3 times a day. Its combination with baclofen is effective [23, 24].

The main drugs used to treat spastic muscle hypertonicity are presented in Table.

Thus, the choice of drug is determined by the underlying disease, the severity of muscle spasticity, as well as side effects and features of the action of a particular drug.

For example, tizanidine and baclofen have a greater effect on the tone of the extensor muscles, therefore, in cases of significant hypertonicity of the arm flexor muscles, slight spasticity of the leg muscles, their administration is not indicated, since a slight increase in the tone of the leg extensor muscles compensates for muscle weakness in the leg and stabilize the patient’s gait. In this case, the means of choice are methods of physical impact on the muscles of the upper limb.

In the treatment of cerebral spasticity, Sirdalud is most often used, and in spinal spasticity, Sirdalud and Baclofen are used. An important advantage over other muscle relaxants is Mydocalm, which does not have a sedative effect and has a favorable tolerance spectrum, therefore it is the drug of choice for outpatient treatment and for the treatment of elderly patients.

A combination of several drugs is acceptable, which allows you to effectively reduce the tone at lower doses of each of the drugs. The combination of drugs with different points of application, ranging from centers in the brain to muscles, can lead to a summation of the therapeutic effect.

The effectiveness of oral antispastic drugs decreases with their long-term use, often there is a need for an increasing increase in dosages to maintain the initial clinical effect, which is accompanied by an increase in the frequency and severity of adverse reactions [25-27].

In a situation where spasticity is local in nature and the systemic effect of oral muscle relaxants is undesirable, local methods of exposure are preferable, one of which is the local administration of botulinum toxin [28, 29].

Literature

1. Skoromets A. A., Amelin A. V., Pchelintsev M. V. et al. Prescription guide for a neurologist. St. Petersburg: Polytechnic. 2000. 342 p.
2. Shtok VN Pharmacotherapy in neurology: A practical guide. 4th ed., revised. and additional M.: OOO Medical Information Agency, 2006. 480 p.
3. Guidelines for the organization of neurological care for patients with strokes in St. Petersburg / Ed. V. A. Sorokoumova. St. Petersburg: St. Petersburg, 2009. 88 p.
4. Lehmann-Horn F., Ludolf A. Treatment of diseases of the nervous system. Moscow: MEDpress-inform. 2005. 528 p.
5. O’Dwyer N., Ada L., Neilson P. Spasticity and muscle contractur in stroke // Brain. 2006 Vol. 119. P. 1737-1749.
6. Damulin IV Spasticity syndrome and the main directions of its treatment // Journal of Neurology and Psychiatry. S. S. Korsakov. 2003. No. 12. S. 4–9.
7. Zavalishin I. A., Barkhatova V. P., Shitikova I. E. Spastic paresis // In the book. Multiple sclerosis. Selected questions of theory and practice. Ed. I. A. Zavalishina, V. I. Golovkina. Elf IPR LLC. 2000, pp. 436–455.
8. Levin OS Essential drugs used in neurology: a Handbook. M.: MEDpress-inform, 2007. 336 p.
9. Boyko A. N., Lashch N. Yu., Batysheva T. T. Increased muscle tone: etiology, pathogenesis, correction // Directory of a polyclinic doctor. 2004. V. 4. No. 1. S. 28–30.
10. Damulin IV Spasticity syndrome and the main directions of its treatment // Journal of Neurology and Psychiatry. S. S. Korsakov. 2003. No. 12. S. 4–9.
11. Selected lectures on neurology: ed. V. L. Golubeva. M.: EidosMedia, 2006. 624 p.
12. Parziale J., Akelman E., Herz D. Spasticity: pathophysiology and management // Orthopaedics. 2003 Vol. 16. P. 801–811.
13. Katz R., Rymer Z. Spastic hypertonia: mechanisms and measurement // Arch. Phys. Med. rehab. 2009 Vol. 70. P. 144–155.
14. Barnes M. An overview of the clinical management of spasticity // In: Upper motor neuron syndrome and spasticity. Cambridge University Press. 2001. P. 5–11.
15. Parfenov VA Pathogenesis and treatment of spasticity // Russian Medical Journal. 2011. V. 9. No. 25. S. 16–18.
16. Kadykov AS, Shakhparanova NV Medical rehabilitation of patients with spastic paresis. In: Syndrome of the upper motor neuron. Ed. I. A. Zavalishina, A. I. Osadchikh, Ya. V. Vlasova. Samara: Samara branch. Litfonda, 2005, pp. 304–315.
17. Kadykov AS, Chernikova LA, Sashina MB Rehabilitation of patients with central post-stroke pain syndrome // Rehabilitology. Collection of scientific papers (annual edition), No. 1. M .: Publishing House of the Russian State Medical University, 2003. P. 357–359.
18. Sashina M. B., Kadykov A. S., Chernikova L. A. Post-stroke pain syndromes // Atmosphere. Nervous diseases. 2004. No. 3. S. 25–27.
19. Kamchatnov P. R. Spasticity — modern approaches to therapy // Russian Medical Journal. 2004. V. 12. No. 14. S. 849–854.
20. Gusev E. I., Skvortsova V. I., Platinova I. A. Ischemic stroke therapy // Consilium medicum. 2003, spec. release. pp. 18–25.
21. Kadykov A. S., Chernikova L. A., Sashina M. B. Post-stroke pain syndromes // Neurological journal. 2003. No. 3. S. 34–37.
22. Musaeva LS, Zavalishin IA Treatment of spasticity in multiple sclerosis // Proceedings of the 9th symposium “Multiple sclerosis: treatment and recovery”. St. Petersburg: Faces of Russia. 2000, pp. 59–60.
23. Stroke. Principles of diagnosis, treatment and prevention / Ed. N. V. Vereshchagina, M. A. Piradova, Z. A. Suslina. Moscow: Intermedica, 2002. 208 p.
24. Sommerfeld D. K., Eek E. U.-B., Svensson A.-K. et al. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations // Stroke. 2004 Vol. 35. P. 134–140.
25. Bakheit A., Zakine B., Maisonobe P. The profile of patients and current practice of treatment of upper limb muscle spasticity with botulinum toxin type A // Int. J. Rehabil. Res. 2010 Vol. 33. P. 199–204.
26. Malakhov V. A. Muscle spasticity in organic diseases of the nervous system and its correction // International neurological journal. 2010. No. 5. S. 67–70.
27. Davis T., Brodsky M., Carter V. Consensus statement on the use of botulinum neurotoxin to treat spasticity in adults // Pharmacy and Therapeutics. 2006 Vol. 31. P. 666–682.
28. Childers M., Brashear A., ​​Jozefczyk P. Dose-dependent response to intra-muscular botulinum toxin type A for upper limb spasticity after stroke // Arch. Phys. Med. rehab. 2004 Vol. 85. P. 1063–1069.
29. Kadykov AS Muscle relaxants in the rehabilitation of patients with post-stroke movement disorders // Journal of Neurology and Psychiatry. S. S. Korsakov. 1997. No. 9. S. 53–55.

A. A. Korolev, Candidate of Medical Sciences

All-Russian Center for Emergency and Radiation Medicine n. a. A. M. Nikiforov, Ministry of Emergency Situations of Russia, St. Petersburg

Contact information about the author for correspondence: [email protected]

types of inexpensive and effective drugs according to the CP version with doctors’ reviews

Muscle relaxants are a generic name for a number of drugs that, due to the action of one or another active substance, allow you to relax skeletal muscles up to complete immobility. Such drugs are used in the treatment of various diseases, as well as for diagnostic purposes, when it is necessary for a person to be conscious, and his muscles should not contract.

Muscle relaxants help relieve excess tension in the lower back, relieve increased muscle tone in patients who have had a stroke, after a traumatic brain or spinal injury, with multiple sclerosis ¹ and a number of other diseases.

There are muscle relaxants of central and peripheral action. The former inhibit the process of excitation in the central nervous system and suppress reflexes. The latter do not affect the neurons of the brain, but act directly on the points of contact of the muscles with the nerve endings.

Important benefits of using muscle relaxants ² :

• helps relieve muscle tension;
• reduce pain;
• improve physical activity;
• allow you to reduce the dose of painkillers and enhance their effect.

Muscle relaxants can be used in combination with analgesics and NSAIDs (non-steroidal anti-inflammatory drugs), as well as in combination with acupuncture and exercise therapy ¹ .

Muscle relaxants have a number of contraindications and side effects. Often while taking the drug, drowsiness, fatigue, dizziness, lethargy are observed. This must be taken into account when choosing a medicine, so you can not do without a preliminary consultation with a doctor.

Types of muscle relaxants

Drugs with a variety of names are available in pharmacies, but three active ingredients are most often used in their composition: baclofen, tolperisone or tizanidine. The choice of one or another muscle relaxant depends on the purpose, the presence of contraindications and possible side effects. We will look at the most popular and safe muscle relaxants that doctors can recommend.

Important! All drugs have side effects and contraindications. Our material is an overview and does not serve as a guide to action. Before buying drugs, consult your doctor.

Muscle relaxants for osteochondrosis

Muscle spasms are a fairly common companion of osteochondrosis. Usually they develop due to constant muscle tension with an incorrect position of the spine and if the resulting hernias compress the nerve endings of the spinal cord. Tolperisone-based drugs can be used to relax muscles. This substance reduces the activity of motor neurons, weakens or eliminates muscle spasm, and also has a slight antispasmodic and analgesic effect.

Tolperisone does not affect the cause of the disease and is used for symptomatic therapy for mild or moderate pain, including back pain.

Tolperisone preparations are available in tablets and as an injectable solution. They are contraindicated in case of individual intolerance, under the age of 18, pregnancy, lactation and such a disease as myasthenia gravis.

Muscle relaxants for trauma and surgery

Some medical procedures can only be performed when the patient’s muscles are completely relaxed. Muscle relaxants of peripheral action, such as suxamethonium iodide and pipecuronium bromide, help to achieve this. They are used only in a hospital under the supervision of a physician.

• Peripheral muscle relaxants block the transmission of neuromuscular impulses and cause complete muscle relaxation for a while. These drugs are available in the form of injection solutions and are used in surgery and traumatology. The duration of their action is different – from 10-15 minutes to 1.5 hours. The drugs do not accumulate in the body, therefore, after the end of their action, the normal muscle tone is restored in a person.

Peripheral muscle relaxants contraindicated in myasthenia gravis, myotonia, angle-closure glaucoma, pregnancy and lactation, acute liver failure and bronchial asthma.

• Centrally acting muscle relaxants can be prescribed for painful muscle spasms that a patient has experienced after trauma or surgery on the spine and joints, for example, for a herniated disc or osteoarthritis of the hip. Baclofen and tizanidine preparations may be used. They have a relaxing effect and reduce excessive muscle tension, thereby reducing pain and restoring normal range of motion.

Contraindications to the use of baclofen and tizanidine: individual intolerance, severe liver dysfunction, age under 18 years. Side effects include nausea, drowsiness, dizziness, and dry mouth.

Muscle relaxants for neuralgia

Neuralgia is a lesion of peripheral nerves, which is accompanied by sharp burning pains in the area where the affected nerve is located. The most common is intercostal neuralgia. There are many reasons for this condition – injuries, intoxications, infectious diseases, some pathologies of the nervous system.

Local anesthetics, strong analgesics, and neuropathic pain medications are prescribed to relieve neuralgia pain. Muscle relaxants are used as a means of adjuvant therapy and, as a rule, only for neuralgia against the background of diseases of the spine. Tolperisone and tizanidine preparations are recommended for use, usually in the form of tablets. They help relax muscles, reduce spasms and pain.

Tizanidine preparations are contraindicated in children and adolescents under 18 years of age, with individual intolerance, severe liver dysfunction, lactase deficiency, lactose intolerance.

How to choose muscle relaxants

The choice of the drug should be treated with particular care, given its purpose. Despite the common “target” – spasm, the list of diseases may vary. It is also important to study the list of contraindications and restrictions.

Many muscle relaxants are “rich” in side effects that may occur with varying degrees of probability, and this must also be taken into account.

Undoubtedly, only a doctor can choose the optimal drug in each case. That is why muscle relaxants are prescription drugs so that a person does not harm himself by self-medicating.

If you think you need a muscle relaxant, ask your doctor about this. Don’t forget to indicate your health conditions (allergies, sensitivity to lactose, lidocaine and other substances, etc.).

Doctors’ opinions about muscle relaxants

Despite the rather long history of the use of muscle relaxants, the opinions of doctors about their appointment still differ.

Some experts recommend the use of muscle relaxants for back pain.

– When used correctly, muscle relaxants significantly improve the quality of life of patients, – notes neurologist of the highest category Olga Lisenkova .

Other physicians consider this treatment inappropriate ³ . A number of physicians are convinced that research data on the effectiveness of muscle relaxants is not enough, so they do not need to be prescribed.

Popular Questions and Answers

How muscle relaxants work and why they should be used with great care, answers Olga Lisenkova, neurologist of the highest category.

When are muscle relaxants used?

– Muscle relaxants (“myo” – muscle, “relax” – relaxation) – a large group of drugs used when muscles need to be relaxed. They are used in anesthesiology (for anesthesia), for back pain (in the form of tablets and injections), for spasticity (painful muscle spasm that occurs with diseases of the nervous system). Spasticity occurs after a stroke, traumatic brain injury, with multiple sclerosis and other diseases.

Why are muscle relaxants dangerous?

— Like all medicines, muscle relaxants have side effects. Overdose may cause excessive muscle weakness, heart rhythm disturbances, dizziness, etc.

How many days can muscle relaxants be taken?

— The course of treatment depends on the diagnosis and condition of the patient. Muscle relaxants can be taken from a few days (for back pain) to a constant daily intake for many years.

Why can’t muscle relaxants be used without a doctor’s prescription?

– These are serious drugs with a lot of side effects and contraindications. The effect often depends on the dose, which is selected individually. It is also very important to consider the risk of interactions with other drugs. Without a doctor, all this is unlikely to be sorted out.

What can replace muscle relaxants if you have neck or lower back pain?

— The two most common triggers for neck and lower back pain: stress and sedentary work.