baclofeni

Baclofeni, or baclofen in English, is a centrally acting medication used as a skeletal muscle relaxant to reduce spasticity. It is indicated primarily for spasticity due to conditions such as multiple sclerosis, spinal cord injury, and certain cerebral palsies. The drug is available in oral form and, for severe cases, as an intrathecal formulation delivered by an implanted pump. Brand names include Lioresal and Gablofen.

The mechanism of action involves stimulation of GABA-B receptors in the spinal cord and brain. This receptor activation inhibits excitatory neurotransmitter release and reduces the activity of motor neurons, leading to decreased muscle tone and spasticity. Baclofen is not a benzodiazepine and does not have significant direct muscle relaxant effects outside the CNS.

Oral baclofen is typically started at a low dose and titrated upward based on response and tolerability. Dosing is individualized, with adjustments made to balance reduction in spasticity against side effects such as drowsiness, dizziness, fatigue, weakness, and nausea. The oral form has a renal excretion pathway, so dose adjustments may be needed in patients with reduced kidney function. Intrathecal baclofen is delivered directly into the cerebrospinal fluid via an implanted pump and is reserved for severe, refractory spasticity when oral therapy is insufficient or poorly tolerated; dosing is highly individualized and requires careful medical supervision.

Common adverse effects include sedation, dizziness, weakness, and hypotension. Abrupt withdrawal after long-term use can cause fever, altered mental status, rebound spasticity, and in rare cases rhabdomyolysis; any plan to discontinue should be gradual under medical supervision. Interactions with other CNS depressants, including alcohol, can enhance sedation. Baclofen is contraindicated in known hypersensitivity and requires caution in pregnancy and renal impairment.