Baclofen: Difference between revisions

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{{MedTemplate

| generic = Baclofen

| brand = Lioresal

| brand = Lioresal (oral, intrathecal pump), Ozobax / Fleqsuvy (oral suspension), Gablofen (intrathecal), Lyvispah (oral granules)

| structure =

| classes = ~~GABAergic~~, ~~Muscle relaxant~~

| classes = [[:Category:Skeletal muscle relaxants|Skeletal muscle relaxant (centrally-acting)]], [[:Category:Antispastics|Antispastic]], [[:Category:GABA-B receptor agonists|GABA-B receptor agonist]]

| ~~mechanism = GABAB~~ receptor agonist

| uses = <vote slug="spasticity-multiple-sclerosis-use">Spasticity in multiple sclerosis (FDA, oral and intrathecal)</vote>, <vote slug="spasticity-spinal-cord-injury-use">Spasticity in spinal cord injury (FDA, oral and intrathecal)</vote>, <vote slug="cerebral-palsy-spasticity-use">Cerebral palsy spasticity (FDA intrathecal; off-label oral)</vote>, <vote slug="alcohol-use-disorder-baclofen-use">Alcohol use disorder (off-label, evidence-supported, generally third-line)</vote>, <vote slug="persistent-hiccups-use">Persistent hiccups (off-label)</vote>, <vote slug="gerd-motility-use">GERD with esophageal motility dysfunction (off-label)</vote>, <vote slug="trigeminal-neuralgia-use">Trigeminal neuralgia adjunct (off-label)</vote>

| uses =

| starting_dose = Oral: 5 mg PO TID, titrate by 5 mg per dose every 3 days. Intrathecal: bolus test dose, then continuous infusion via implanted pump

~~| starting_dose~~ =

| preparations = Tablets 5, 10, 20 mg; oral suspension 5 mg/5 mL (Ozobax, Fleqsuvy); intrathecal injection 50, 500, 1000, 2000 mcg/mL (Lioresal Intrathecal, Gablofen); oral granules (Lyvispah)

~~| preparations~~ =

| fda_max = 80 mg/day oral (higher off-label)

~~| routes~~ =

| pill_id =

~~| onset~~ =

| routes = Oral, intrathecal (via implanted infusion pump)

~~| duration~~ =

| onset = 1-2 hours (oral)

~~| halflife~~ =

| duration = 4-6 hours (oral, TID-QID dosing)

~~| bioavailability~~ =

| halflife = 3-4 hours<ref name="lioresal-label">FDA Prescribing Information, Lioresal (baclofen), Saol Therapeutics/Novartis, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/017851s019lbl.pdf</ref>

| ~~pregnancy~~ =

| bioavailability = ~70-85% (oral)<ref name="lioresal-label" />

| ~~legal~~ =

| pregnancy = Limited human data.{{citation needed}}

| ~~intro~~ =

| legal = [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance<ref name="lioresal-label" />

| ~~pharmacokinetics~~ =

| mechanism = <vote slug="baclofen-mech-claim">Selective agonist at the GABA-B receptor (the only metabotropic GABA receptor; distinct from the ionotropic GABA-A targeted by benzodiazepines and Z-class hypnotics). Reduces excitatory neurotransmitter release presynaptically and hyperpolarizes postsynaptic membranes, producing antispastic effect particularly at spinal cord interneurons.</vote> '''Severe withdrawal syndrome''' is the marquee adverse-event concern, especially with abrupt cessation of intrathecal administration: hyperthermia, altered mental status, hyperreflexia, rhabdomyolysis, and multiorgan failure can develop within 24-72 hours and progress to death. Gradual taper is essential after extended use; intrathecal pump failures are a recognized emergency<ref name="lioresal-label" />.

| ~~pharmacodynamics~~ =

| ~~indications =~~

~~| dosing~~ =

| ~~effects~~ =

| ~~contraindications~~ =

~~| interactions~~ =

| ~~pregnancy_details~~ =

~~| monitoring~~ =

| ~~counseling~~ =

| ~~anecdotes~~ =

| ~~seealso~~ =

| ~~references~~ =

}}

~~[[Category:Sedative-Hypnotics]]~~

== References ==

[[Category:Skeletal muscle relaxants]]

[[Category:Antispastics]]

[[Category:GABA-B receptor agonists]]

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