Baclofen

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  • Class of drug: Skeletal muscle relaxant.
  • Mechanism of action: Inhibits mono- and polysynaptic reflexes within the spinal cord resulting in decreased spasticity.
  • Indications/dosage/route: Oral only.
  1. Spasticity of multiple sclerosis and spinal cord lesion

Adults: Initial: 15 mg/d, may increase dose every 3 days by 5–15 mg/d. Maximum: 80 mg/d, q8h.
Ð Children 2–7 years: Initial: 10–15 mg/kg/d, may increase dose every 3 days by 5–15 mg/d. Maximum: 40 mg/d.
Ð Children >8 years: Initial: 10–15 mg/d, titrate dose as above. Maximum: 80 mg/d.

  • Adjustment of dosage

• Kidney disease: reduce dose.
• Liver disease: no reduction required.
• Elderly: reduce dose.

  • Contraindications: Hypersensitivity to baclofen.
  • Warnings/precautions

Use with caution in patients with the following conditions:
Seizures, decreased renal function.
• Seizure threshold may be lowered in epileptics.
• Patients requiring spasticity to maintain posture and balance may worsen with treatment.
• Avoid abrupt withdrawal.

  • Advice to patient
  1. Avoid alcohol and other CNS depressants such as opiate analgesics and sedatives (eg, diazepam) when taking this drug.
  2. Change position slowly, in particular from recumbent to upright, minimizing orthostatic hypotension. Sit at the edge of the bed for several minutes before standing, lie down if feeling faint or dizzy. Avoid hot showers or baths and standing for long periods. Male patients with orthostatic hypotension may be safer urinating while seated on the toilet rather than standing.
  3. Avoid driving and other activities requiring mental alertness or that are potentially dangerous until response to drug is known.
  4. Do not stop drug abruptly as this may precipitate withdrawal reaction (anxiety, hallucinations, tachycardia, seizures).
  • Adverse reactions
  1. Common: slurred speech, dizziness, drowsiness.
  2. Serious: psychiatric abnormalities, confusion, syncope, dyspnea, hallucinations, depression.
  • Clinically important drug interactions

Drugs that increase effects/toxicity of balclofen: antihistamines, sedatives, opioids, CNS depressants, alcohol, MAO inhibitors.

  • Parameters to monitor

Evaluate patient for orthostasis.
• Monitor for sedation and CNS side effects.
• Signs of hypersensitivity reactions.

  • Note: Food: Take with food or milk.

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