Baclofen
LIORESAL
Pronunciation: BAK-loe-fen
“Liar’s resale Back fin”
intrathecal baclofen pump
hat resembles GABA-B agonist peg
What it isGABA-B receptor agonist; spasticity of spinal origin.
Why this oneIntrathecal delivery makes it uniquely useful for severe spinal spasticity when oral sedation prevents adequate treatment.
What limits itRenal accumulation can cause encephalopathy; abrupt withdrawal can cause rebound spasticity, delirium or seizures — especially from a pump.
Baclofen prescription history
Animated chart of estimated U.S. prescriptions per year, Muscle relaxants (1950–2026). Baclofen enters in 1977 (estimated).
FDA-approved for
- spasticity (1977)
Off-label
- alcohol use disorder
- hiccups
Principal riskAbrupt withdrawal can cause seizures and rebound spasticity
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Spasticity (e.g., multiple sclerosis, spinal cord conditions) | Adult | 5 mg TID | 40-80 mg/day divided (titrate) | 80 mg/day (20 mg QID) |
Titration Increase dose every 3 days per titration schedule
Renal Undefined
Hepatic Undefined
Instructions
- Titrate to lowest dose compatible with optimal response
- Do not stop abruptly — withdraw slowly to avoid withdrawal (hallucinations, seizures, rebound spasticity)
Available strengths
- tab 5, 10, 15, 20 mg
- inj 0.05, 0.5, 1, 2 mg/mL
- granules 5, 10, 20 mg/packet
- sol 5, 10 mg/5 mL
- susp 25 mg/5 mL
Cautions
- Abrupt withdrawal can cause hallucinations and seizures — taper
- Caution where spasticity maintains upright posture/balance or function
- Transient drowsiness — may impair ability to operate machinery/drive
Adverse reactions
- Transient drowsiness (10-63%)
- Dizziness (5-15%), weakness (5-15%)
- Fatigue
- Nausea (4-12%), constipation
- Hypotension, headache, insomnia
Pregnancy Undefined
Lactation Undefined
Cost
Generic entry1988
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Memory aids: interaction avatars
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Self-check
- What can renal baclofen accumulation cause?
Encephalopathy. - Why is abrupt pump withdrawal especially concerning?
Rebound spasticity, delirium or seizures.