Lioresal (Baclofen)
Also sold as: Lioresal, Bacloren, Bacpas, Baqofen, Gabafen
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 5mg, 10mg, 25mg +1
Indications
- Spasticity due to multiple sclerosis (MS), spinal cord injury, cerebral palsy, stroke
- Hiccups (intractable — off-label)
- Alcohol use disorder (GABA-B mechanism — off-label; evidence emerging for craving reduction)
- Trigeminal neuralgia (adjunct — off-label)
Adult Dosing
Spasticity (MS, SCI)
Start 5 mg PO TDS; increase by 5 mg per dose every 3 days as tolerated. Usual: 30–75 mg/day. Max: 100 mg/day (oral).
Slow titration essential. Individual variation large — some patients need 80–100 mg; others respond to 20 mg.
Intractable hiccups
5–10 mg PO TDS
Short-course; review at 2 weeks
Pediatric Dosing
Cerebral palsy: intrathecal baclofen pump (specialist) for severe refractory spasticity
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 15 mL/min | Reduce dose significantly — renally excreted; severe accumulation risk in renal failure. Consider intrathecal route. |
Hepatic Adjustment
No specific dose adjustment — not significantly hepatically metabolised
Pregnancy & Lactation
Pregnancy: Category C
Use only when benefit outweighs risk — spasticity management in pregnancy challenging. Neonatal withdrawal syndrome reported with maternal baclofen use (hypotonia, respiratory depression, seizures — manage in NICU). Avoid if possible in 1st trimester.
Lactation: Caution
Excreted in small amounts in breast milk — generally considered acceptable if medically necessary. Monitor infant for hypotonia and sedation.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| CNS depressants (benzodiazepines, opioids, alcohol, antipsychotics) | Additive CNS and respiratory depression — significant risk of overdose and coma | Major |
| Antihypertensives | Additive hypotension | Moderate |
| TCAs (amitriptyline, imipramine) | Additive CNS depression; hypotonia | Moderate |
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Side Effects
Common
- Drowsiness (most common — dose-dependent)
- Fatigue and weakness (especially legs — can worsen functional ability)
- Dizziness
- Nausea
- Confusion (elderly)
- Dry mouth
- Urinary retention
Serious / Discontinue If
- ⚠️ ABRUPT WITHDRAWAL — LIFE-THREATENING: baclofen withdrawal causes severe rebound spasticity, hallucinations, seizures, hyperthermia, multi-organ failure, DEATH. NEVER stop suddenly after prolonged use. Taper gradually.
- Respiratory depression (high doses — especially intrathecal)
- Coma (overdose or rapid dose increase)
- Seizures (paradoxical — overdose)
- Intrathecal pump failure (catastrophic withdrawal or overdose)
Contraindications
- Peptic ulcer disease (use cautiously)
- Epilepsy (can lower seizure threshold)
- Psychiatric disorders (may worsen psychosis)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Lioresal 10mg | Novartis | 30 tab ₹185 |
| Bacloren 10mg | Sun Pharma | 30 tab ₹75 |
| Bacpas 10mg | Cipla | 30 tab ₹68 |
| Gabafen 10mg | Torrent | 30 tab ₹72 |
Monitoring Required
- Spasticity (Ashworth scale at each visit)
- Functional status (walking, transfers)
- Sedation/drowsiness level
- Blood pressure (orthostatic)
- Renal function (dose adjustment)
- Seizure history
Patient Counseling Points
- ⚠️ NEVER stop baclofen suddenly after taking for more than a few weeks — LIFE-THREATENING withdrawal. Always taper slowly under medical guidance.
- Drowsiness is common at first — usually improves with time; do not drive initially
- Weakness in legs may increase temporarily — sit or lie when drowsy
- Avoid alcohol — dangerous interaction (excessive sedation)
- Take with food to reduce nausea
- If you miss doses due to vomiting or inability to swallow — contact doctor immediately (withdrawal risk)
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Clinically reviewed by: Dr. Arun Hegde, MS (Orthopaedics), Consultant Orthopaedic Surgeon
Last reviewed: 2026-04-01
References
- NICE MS Spasticity Guidelines
- BNF — Baclofen
- FDA Baclofen Prescribing Information
- Cochrane — Baclofen for Spasticity
- Neurological Society of India — Spasticity Management