Baclofen
Administration
- Type: Muscle relaxant/anti-spasmodic
- Dosage Forms: tablet, intrathecal solution, preservative free intrathecal solution
- Dosage Strengths: tablet: 10, 20mg; intrathecal solution: 50, 500mcg/mL; preservative free intrathecal solution: 500, 1000, 2000 mcg/mL
- Routes of Administration: oral, intrathecal
- Common Trade Names: Lioresal, Gablofen
Adult Dosing
- 5-20mg PO 3-4 times/day
- maintenance intrathecal rate after titration: 22 to 1400 mcg/day
Pediatric Dosing
- 2-7yo: 10 to 15 mg/day PO in 2-3 divided doses, titrate to max 40mg/day in 3-4 divided doses
- >7 yo: 10 to 15 mg/day PO in 2-3 divided doses, titrate to max 60mg/day in 3-4 divided doses
- <12 yo: maintenance intrathecal rate after titration- 24 to 1199 mcg/day
Special Populations
- Pregnancy Rating: C
- Lactation risk: Infant risk minimal
Renal Dosing
- CrCl 50-80 mL/min: reduce dose by 1/3
- CrCl 30-50 mL/min: reduce dose by 1/2
- CrCl <30 mL/min: reduce dose by 2/3
- If HD, use intrathecal with caution, likely reduce dose
Hepatic Dosing
- No adjustment
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- GI bleed
- Coma
- Seizure
- Aseptic meningitis
- Pneumonia
- Withdrawal
Common
- Hypotension
- Nausea/vomiting, constipation
- Dizziness, somnolence, asthenia, poor muscle tone
- Urinary complications
Pharmacology
- Half-life: 5 hours (oral), 1.5-4 hours (intrathecal)
- Metabolism: Hepatic (15%)
- Excretion: Mostly renal
Mechanism of Action
- GABA-B agonist
Comments
See Also
References
- Abarbanel J, Herishanu Y, Frisher S, “Encephalopathy Associated With Baclofen,” Ann Neurol, 1985, 17(6):617-8. [PubMed 4026235]
- Addolorato G, Leggio L, Ferrulli A, et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomized, double-blind controlled study. Lancet. 2007;370:1915-1922. [PubMed 18068515]
- Agarwal SK, Kriel RL, Cloyd JC, et al. A pilot study assessing pharmacokinetics and tolerability of oral and intravenous baclofen in healthy adult volunteers. J Child Neurol. 2015;30(1):37-41. [PubMed 25028414]10.1177/0883073814535504
- Aisen ML, Dietz M, McDowell F, Kutt H. Baclofen toxicity in a patient with subclinical renal insufficiency. Arch Phys Med Rehabil. 1994;75(1):109-111. [PubMed 8291951]
- Albright AL, “Baclofen in Treatment of Cerebral Palsy,” J Child Neurol, 1996, 11(2):77-83. [PubMed 8881981]
- Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
- ASHP. Standardize 4 Safety Initiative Compounded Oral Liquid Version 1.01. July 2017. https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/s4s-ashp-oral-compound-liquids.ashx?la=en&hash=4C2E4F370B665C028981B61F6210335AD5D0D1D6.
- Averbuch-Heller L, Tusa RJ, Fuhry L, et al. A double-blind controlled study of gabapentin and baclofen as treatment for acquired nystagmus. Ann Neurol. 1997;41(6):818-825. [PubMed 9189045]
- Baclofen tablet [prescribing information]. Pulaski, TN: AvKare Inc; April 2014.
- Brunton LL, Chabner BA, Knollmann BC, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-Hill Medical; 2011.