GENERIC NAME: baclofen

BRAND NAME: Lioresal

DRUG CLASS AND MECHANISM: Baclofen is a muscle relaxant. Chemically, baclofen is related to gamma-aminobutyric acid (GABA) which is a naturally-occurring neurotransmitter in the brain, that is, a chemical that nerves use to communicate with one another. GABA released by some nerves causes the electrical activity of other nerves to decrease. It is believed that baclofen, by acting like GABA, blocks the nerves within the reticular formation of the brain that control the muscles. Baclofen was approved by the FDA in November 1977.

GENERIC AVAILABLE: Yes

PRESCRIPTION: Yes

PREPARATIONS: Tablets: 10mg and 20mg.

STORAGE: Tablets should be stored between 15° (59°F) and 30°C (86°F).

PRESCRIBED FOR: Baclofen is used to treat spasticity of the skeletal muscles and improve mobility in patients with multiple sclerosis by decreasing muscular spasm and rigidity. Baclofen also improves bowel and bladder function in some patients.

DOSING: In adults, 5 mg usually is given three times per day, with the dose gradually increased to 40-80 mg/day given in divided doses. Children ages 2 years and above are started at an initial dose of 10-15 mg/kg/day orally in 3 divided doses with the dose gradually increased to a dose of 40-60 mg/day. Baclofen may be administered with food or milk to minimize abdominal pain .

DRUG INTERACTIONS: Use of baclofen with other central nervous system (CNS) depressants--e.g. ethanol, opiate agonists such as Percocet, Dilaudid-antipsychotics--e.g. Thorazine, Stelazine, Haldol-anxiolytics--e.g. Valium, Ativan, Ambien--certain antihistamines--e.g. Benadryl, Vistaril, Tavist)--can increase CNS depression .

In addition to the risk of central nervous system (CNS) depression, the use of baclofen and tricyclic antidepressants--e.g. Elavil, Sinequan--may cause muscle weakness. Use of baclofen and monoamine oxidase inhibitors-e.g. Nardil, Parnate can result in greater CNS depression as well as low blood pressure . Because baclofen can increase blood sugar, doses of antidiabetic agents may need to be adjusted when baclofen is begun.

PREGNANCY: The effects of baclofen on the fetus are unknown. Physicians need to balance the benefits of the medication with the potential risks before prescribing baclofen during pregnancy.

NURSING MOTHERS: The effects of baclofen in nursing infants are unknown. It is advisable that baclofen not be used by nursing mothers or that infants be bottle-fed.

SIDE EFFECTS: The most common side effects seen with oral baclofen therapy include drowsiness, weakness, dizziness or lightheadedness, headache, nausea, vomiting, low blood pressure, constipation , tiredness, confusion, inability to sleep , and increased urinary frequency.

There have been several cases of severe baclofen reactions (change in mental status, severe abdominal pain, seizures and respiratory depression) in patients with impairment of kidney function. Therefore, baclofen probably should not be used if there is important kidney impairment, and alternative therapies should be considered.

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