Baclofen is a skeletal muscle relaxant and antispastic agent that acts primarily at the spinal cord level. It is commonly prescribed for muscle spasticity associated with multiple sclerosis, spinal cord injuries, and other neurological conditions.
Generic name: Baclofen
Brand names: Lioresal, Gablofen, Lyvispah
Pharmacologic class: Gamma-aminobutyric acid (GABA) derivative
Therapeutic class: Skeletal muscle relaxant, antispastic agent
Mechanism of action: Baclofen acts as a GABA-B receptor agonist, primarily at the spinal cord level. It inhibits both monosynaptic and polysynaptic reflex transmission, resulting in muscle relaxation and reduced spasticity.
Indications for use: Treatment of spasticity resulting from multiple sclerosis, spinal cord injuries, cerebral palsy, stroke, and other spinal cord diseases. Also used to treat chronic hiccups and alcohol use disorder.
Precautions and contraindications: Hypersensitivity to baclofen, severe psychiatric disorders, epilepsy, acute or chronic renal failure, and pregnancy (Category C). Use with caution in elderly patients and those with respiratory conditions.
Drug Interactions
- CNS depressants (including alcohol, benzodiazepines, opioids) – increased sedation
- Antihypertensive medications – enhanced hypotensive effect
- Tricyclic antidepressants – increased muscle relaxation
- MAO inhibitors – possible increased hypotension
- Levodopa/carbidopa – increased risk of confusion and hallucinations
Adverse Effects
- Drowsiness, sedation, dizziness
- Weakness, fatigue
- Confusion, depression
- Headache
- Insomnia
- Nausea, constipation
- Urinary retention or frequency
- Hypotension
- Respiratory depression
- Withdrawal syndrome (with abrupt discontinuation)
Administration Considerations
Available preparations: Oral tablets (10mg, 20mg), oral solution, intrathecal solution
Dosages:
- Oral: Start with 5mg TID, gradually increase to 20mg QID
- Maximum daily dose: 80mg/day
- Intrathecal: Individualized dosing based on response
Onset, Peak, and Duration:
- Oral onset: 1 hour
- Peak effect: 2-3 hours
- Duration: 4-8 hours
- Intrathecal onset: 30-60 minutes
- Peak effect: 4 hours
- Duration: 4-8 hours
Nursing Considerations for Baclofen
Related Nursing Diagnoses
- Risk for injury related to muscle weakness and sedation
- Impaired physical mobility related to muscle spasticity
- Risk for falls related to muscle weakness and dizziness
- Risk for autonomic dysreflexia in spinal cord injury patients
- Deficient knowledge related to medication regimen
Nursing Assessment
- Assess baseline muscle spasticity, strength, and functional ability before administration.
- Evaluate vital signs, particularly blood pressure and respiratory rate.
- Assess mental status and level of consciousness.
- Screen for kidney function, as baclofen is primarily excreted through the kidneys.
- Evaluate for history of seizures or psychiatric disorders.
Nursing Interventions
- Monitor spasticity reduction and functional improvement regularly.
- Implement fall precautions due to muscle weakness and sedation.
- Monitor for signs of baclofen toxicity: confusion, respiratory depression, seizures.
- For intrathecal therapy, assess pump function and insertion site regularly.
- Never abruptly discontinue baclofen due to the risk of withdrawal syndrome.
Patient Teaching Associated with Baclofen
- Take medication exactly as prescribed, at evenly spaced intervals throughout the day.
- Do not stop taking baclofen suddenly; the dose must be gradually reduced under medical supervision.
- Avoid alcohol and other CNS depressants while taking baclofen.
- Use caution when operating machinery or driving due to sedation and dizziness.
- Report any unusual symptoms, particularly severe drowsiness, confusion, or muscle weakness.
- Rise slowly from sitting or lying positions to prevent orthostatic hypotension.
- Maintain good oral hygiene, as baclofen can cause dry mouth.
- Store medication at room temperature, away from heat and moisture.
This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.
References
- Ghanavatian, S., & Derian, A. (2023). Baclofen. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519505/
- Dastgheib, S. S., Martinelli, A. N., Abdelwahab, M. G., Methvin, I., & Ramirez-Zamora, A. (2021). Baclofen in the Treatment of Muscle Spasticity: A Systematic Review and Meta-Analysis. Movement Disorders Clinical Practice, 8(4), 508-516.
- Nielsen, J. F., Hansen, H. J., Sunde, N., & Christensen, J. J. (2022). Evidence-based review of oral baclofen versus intrathecal baclofen for treatment of spasticity. Journal of Rehabilitation Medicine, 54, jrm00263.
- Zajac, A., Sternbach, G. L., & Varon, J. (2021). Baclofen withdrawal syndrome: Recognition and management in the emergency department. American Journal of Emergency Medicine, 49, 158-162.
