Baclofen is used for spasticity which can result from damage to the spinal cord. It acts within the spinal cord and reduces transmission of nerve impulses to muscle. It has a fairly short action which means that you will need to take the drug 3 to 4 times daily.
Your physician will start you on the low dose such as 5 mg, 3 or 4 times per day. The doses gradually increase every few days but it may take several weeks to get to the maximum benefit. The maximum dose baclofen is 160 mg per day and this medication should never be stopped suddenly.
Temporary drowsiness, fatigue, nausea, vertigo, dizziness are sometimes noticed. These effects usually only last a short time of 2 to 3 days. Notify your doctor should these effects persist or if you notice other bothersome side effects. You may notice some of these side effects each time your baclofen dose is increased.
Baclofen does not actually cause weakness. The perception of weakness is due to a reduction in spasticity when you are using the spasticity for some functional activity. The fact that spasticity may be useful for some things while interfering with others needs to be considered when making treatment choices as to whether to increase your medication.
Baclofen should not be mixed with alcohol or other drugs as explained earlier. Sudden discontinuation of baclofen, like many centrally acting medications, can cause withdrawal seizures.
Dantrolene (Dantrium)
Dantrolene acts directly in the muscle to produce a decrease in spasticity and a decrease in muscle stiffness.
Dosage
Dantrolene is generally taken 3 to 4 times daily. You begin with a low dose of 25 mg (one capsule), 2 to 3 times daily, and gradually increase the dose every few days until your spasticity is reduced to a manageable level. Maximum doses range to 400 mg/day.
Side effects
Drowsiness, light-headedness, diarrhea, nausea, fatigue and muscle weakness can occur but usually these effects are temporary. They occur at the beginning of therapy and when doses are increased. Should these side effects become bothersome or persist longer than a few days, contact your doctor.
Precautions
Dantrolene can cause some liver irritation or damage, especially in persons with liver disease. Increased age or certain drugs can also increase the risk.
While you are taking dantrolene, your doctor should schedule you for blood tests regularly to check your liver function. Avoid alcohol while taking dantrolene. Alcohol can greatly increase liver damage. Dantrolene can also increase your sensitivity to sun exposure and risk of sunburn. So stay out of the sun, cover up while outside or use an adequate sunblock.
Lorazepam (Ativan), Diazepam (Valium) and Clonazepan (Rivitril)
These drugs belong to a class of drugs called benzodiazepines. Benzodiazepines produce sedative, muscle relaxation, and anti-seizure effects. Your doctor may prescribe low doses of one of these, in addition to other muscle relaxants, if you spasticity is not well enough controlled.
Dosage
Diazepam is a long-acting drug. It is generally taken once or twice daily. Your doctor will start you at a low dose, which may be increased gradually. Doses vary from 2 to 15 mg/day. Lorazepam can be taken up to 3 times daily. Doses vary from 1 to 3 mg/day. Clonazepam is taken 1 to 2 times per day and doses vary from 0.5 to 2 mg/day.
Precautions
One of the disadvantages of benzodiazepines is that tolerance can develop and you have to take increasingly higher doses of the drug to get a good effect. These drugs should be used with caution, particularly if you have a history of addiction as they can be habit forming. When benzodiazepines are mixed with alcohol, other sedatives or painkillers, overdose can occur. Use caution when driving your car or operating any hazardous machinery when on these drugs.
Side effects
Benzodiazepines can make you drowsy and dizzy, particularly when you first start taking them. Muscle weakness is another common side effect during the first few days of therapy. Should weakness, drowsiness or dizziness persist, tell your doctor. If you experience nausea, vomiting, constipation or develop a skin rash, tell your doctor.
Avoid alcohol when taking diazepam or lorazepam.
Tizanidine (Zanaflex)
Tizaidine has similar efficacy to baclofen in reducing spasticity. The starting dose is 2 mg daily and then is gradually increased every few days until you achieve a good response. It takes some time to get the maximum effect. The maximum dose is 36 mg/day. Side effects include sedation and dry mouth. Before starting Zanaflex, liver function needs to be checked and then checked again at 1, 3, 6 and 12 months. If liver function changes, the medication needs to be gradually withdrawn at your doctor’s direction. On an ongoing basis, it is probably wise to check liver function twice yearly.