Baclofen 10 mg effects

Baclofen

Baclofen is a prescription drug used to treat muscle spasms from multiple sclerosis and Huntington’s disease as well as spinal cord injuries and spinal cord diseases.

Medical experts do not recommend baclofen for muscle spasms caused by rheumatoid arthritis, cerebral palsy, Parkinson’s disease, or stroke, because research to date does not support such use.

Baclofen is an antispastic muscle relaxant. Researchers don’t know exactly how baclofen works; however, in general, it blocks nerve signals from muscles at the level of the spinal cord and it may also depress the central nervous system.

The Food and Drug Administration (FDA) approved baclofen in 1977 under the brand name Lioresal, which was made by Novartis. The FDA approved generic baclofen in the 1980s.

Today, only generic versions of baclofen are available.

A case report published in Therapeutic Advances in Psychopharmacology in 2014 suggested that baclofen might be effective for treating marijuana dependence, particularly for those who have used the drug heavily for a long time. The research also showed that baclofen may help reduce withdrawal symptoms as well as the effects of marijuana.

A separate study, published in the Journal of Neuroscience in 2014, found that baclofen may also help people with drug addiction avoid possible triggers and prevent relapse. The drug works by interfering with the brain’s early response to drug cues.

Baclofen Pump

You can take baclofen as a pill or via an intrathecal baclofen (ITB) pump.

In ITB therapy, your doctor will insert a small catheter under the skin of your abdomen, near your waist. The pump stores and releases the prescribed amount of baclofen through the catheter, using a small motor, directly into your spinal fluid.

ITB can be an option for people who experience side effects taking baclofen in pill form as it requires smaller doses of the drug and thus keeps side effects to a minimum.

Your doctor will need to refill your ITB pump system every one to three months. The system battery typically lasts five years, at which time your doctor will need to replace the device.

Baclofen Warnings

Once you start taking baclofen, don’t stop taking it suddenly on your own. If you need to stop, your doctor will lower your dose gradually.

Stopping baclofen suddenly can lead to a dangerous withdrawal reaction that can include hallucinations (seeing or hearing things that are not there) and seizures.

Your kidneys eliminate baclofen from your system. Take baclofen with caution if you have kidney disease and reduced kidney function because the drug can build up in your system.

Baclofen is not recommended to treat muscle spasms caused by a stroke. Baclofen can cause more side effects in people with a history of stroke.

Baclofen can make you drowsy and affect your balance, so don’t drive or operate heavy machinery until you know how baclofen affects you.

Other conditions you should tell your doctor about before taking baclofen include:

  • Kidney disease
  • Parkinson’s disease
  • Stroke
  • Seizures (epilepsy)
  • Ulcers
  • Cerebral palsy
  • Mental health or mood disorders such as schizophrenia
  • Rheumatoid arthritis

The FDA has not approved baclofen for children younger than 12.

Baclofen and Pregnancy

Studies have linked baclofen to birth defects in animals. Because of this, it is considered unsafe to use during pregnancy.

Before taking this drug, tell your doctor if you are pregnant or may become pregnant.

Baclofen may pass into breast milk, so also tell your doctor if you are breastfeeding or plan to breastfeed.

If you’re a woman, ask your doctor about a possible risk for developing ovarian cysts while on baclofen. Make sure you doctor knows if you have a history of ovarian cysts.

Baclofen “High” and Recreational Use

Numerous online and anecdotal reports have suggested that some people abuse baclofen for a narcotic-like “high,” because it can cause drowsiness.

There is a high risk of overdose associated with recreational use of baclofen, as high doses are needed for narcotic-like effect. Baclofen overdose can lead to:

  • Coma
  • Hypothhermia
  • Dangerously slow heart rate/bradycardia
  • High blood pressure/hypertension
  • Hyporeflexia (slower than normal reflexes)

Take baclofen only as directed by your doctor, and keep this and all other drugs away from children, teenagers, and anyone for whom the drug has not been prescribed.

How Long Baclofen Stays in Your System

The prescription drug baclofen is often prescribed for spinal disorders and injuries and muscle spasms due to multiple sclerosis. It is intended as an antispastic and muscle relaxant, but in recent years it has also been used to treat symptoms of alcohol withdrawal.

Baclofen is administered either as a pill or as a solution delivered intrathecally, meaning through a catheter or injection into the spine. Some brand names for baclofen include Lioresal, Liofen, and Gablofen.

Begin the path to lasting recovery.

Call Now
(443) 819-1388

Baclofen doesn’t cause euphoria (a “high”), but it does have sedative, or calming, effects. It’s important to follow the baclofen dosing directions carefully. If someone takes too much baclofen either accidentally or intentionally, the overdose can result in dangerous and even deadly symptoms.

It’s possible to become dependent on baclofen. If someone has been taking baclofen for a while and they stop taking it suddenly, they will likely experience uncomfortable withdrawal symptoms. Read more below to learn about baclofen half-life, detoxing from baclofen, and how long it takes for baclofen to leave your system.

How Long Does Baclofen Stay in Your System?

Baclofen is available as 10 mg or 20 mg oral tablets or as a solution that is administered into the spine through an injection or intrathecal pump. For muscle or spinal cord disorders, the total daily dose of oral baclofen is usually no more than 80 mg.

Baclofen is also used to treat alcohol withdrawal symptoms. Dosages for this treatment are usually higher than 80 mg. If you have any questions about your baclofen prescription or dosage, contact your healthcare provider. Don’t make any changes to your dosage without speaking with your doctor first.

So, how long does baclofen stay in your system? The half-life of baclofen is about two to four hours. Because of this, a baclofen prescription usually requires frequent dosing to maintain its effects.

If you have been taking baclofen regularly, particularly for a long time, don’t stop taking it suddenly. This can result in baclofen withdrawal symptoms. It can take 48 hours before baclofen withdrawal symptoms occur. They usually peak within 72 hours. Early symptoms may include itchiness, irritability, nausea, and vomiting. As the withdrawal continues, other more severe symptoms may develop, including irregular heartbeat, seizures, and hallucinations. Unmonitored baclofen withdrawal can even result in death.

Can Baclofen Affect a Drug Test?

If you are taking a drug test, you shouldn’t have to worry about baclofen causing any problems. Most drug panels employers use test for five kinds of drugs, which are mostly “street” drugs with the exception of some opioids. These five drugs are:

  • Marijuana
  • Cocaine
  • PCP
  • Opiates (such as heroin, morphine, codeine, etc.)
  • Amphetamines

Some larger drug panels test for additional drugs such as prescription opioids, benzodiazepines, and stimulants in addition to amphetamines, among others. Baclofen is not included on these panels because it’s not a controlled substance and it’s not an opiate. While some prescription drugs may interfere with drug tests, particularly prescription opioids, baclofen typically doesn’t cause any problems.

Baclofen would only show up on a drug panel if, for some reason, it was included in the test. If that’s the case, given its half-life, baclofen would be detectable in a blood sample for about a day. It’s excreted from the body through urine, so it could show up in a urine drug screening for about two days. It’s possible that it might be detectable longer in the case of someone who took a large dose of the drug.

How Long Does It Take to Detox from Baclofen?

If you’ve been struggling with a baclofen dependence and you’re ready to stop, quitting cold turkey may sound like a good idea. But it’s not. Suddenly stopping baclofen can result in uncomfortable and even dangerous withdrawal symptoms. The best way to safely withdraw from baclofen and ensure your best chance for recovery is to participate in a professional medical detox program.

The medical detox process may take a few days. During this time a medical team will closely monitor you. They will take steps to help alleviate the physical discomfort of baclofen withdrawal symptoms while you eliminate the drug from your system. Counseling support will also be provided to help you manage the psychological and emotional aspects of baclofen detox.

Once you have completed the medical detox process, it’s ideal to continue treatment with a full continuum of care, which takes you through progressively less intense levels of treatment. After detox, the next step would be to either continue with further inpatient treatment or move into a partial hospitalization program. This type of program allows you more flexibility than an inpatient program where you are monitored 24/7. However, your doctor may recommend inpatient care if you have any co-existing medical or psychological conditions or any other substance use disorders.

The next stage after partial hospitalization is outpatient treatment, which allows you to live independently and participate in counseling sessions and other forms of therapy a few times a week. Once you have completed an outpatient program, then you move into an alumni or aftercare program that provides opportunities for ongoing support as you adjust to life outside of the treatment program.

If you participate in a full continuum of care from detox through aftercare, your treatment program may last several weeks to a few months. Finding the best care for you will depend on your treatment needs, your doctor’s recommendations, and your financial situation.

Conclusion

Baclofen is a muscle relaxer that is often prescribed for spinal disorders and injuries and muscle spasms due to multiple sclerosis. It’s available in pill form or as an intrathecal solution. Baclofen can be habit-forming. It has a short half-life and usually requires frequent dosing.

Don’t stop taking baclofen suddenly because it may cause severe withdrawal symptoms. Speak with your doctor or healthcare provider before making any changes to your baclofen dosage. If you are struggling with an addiction to baclofen, find a reputable medical detox program to guide you through withdrawal and help position you for a successful recovery.

(2019, April 2) Baclofen. from https://www.rxlist.com

Generic Name: baclofen (BAK loe fen)
Brand Names: Lioresal Intrathecal, Gablofen, FIRST Baclofen

Medically reviewed by Kaci Durbin, MD Last updated on Dec 29, 2018.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

What is baclofen?

Baclofen is a muscle relaxer and an antispasmodic agent.

Baclofen is used to treat muscle symptoms; such as spasm, pain and stiffness; caused by multiple sclerosis, spinal cord injuries, or other spinal cord disorders. It is given intrathecally (directly into the spinal cord) or orally (by mouth).

Important information

Do not use baclofen at a time when you need muscle tone for safe balance and movement during certain activities. Do not drive or operate heavy machinery until you know how baclofen affects you.

Do not stop using baclofen suddenly, or you could have unpleasant withdrawal symptoms.

Before taking this medicine

You should not use baclofen if you are allergic to it.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

  • kidney disease;

  • ulcers;

  • epilepsy or other seizure disorder;

  • Parkinson’s disease, cerebral palsy, or rheumatoid disorders;

  • mental disorders such as schizophrenia or bipolar disorder;

  • diabetes;

  • hypertension;

  • a stroke or blood clot; or

  • if you also use a narcotic (opioid) medication.

Using baclofen may increase your risk of developing an ovarian cyst. Talk with your doctor about your specific risk.

Baclofen has not been studied in pregnant women. Tell your doctor if you are pregnant or if you become pregnant while using this medicine.

It is not known whether baclofen passes into breast milk or if it could harm a nursing baby. Tell your doctor you are breastfeeding before using baclofen.

Baclofen is not approved for use by anyone younger than 12 years old.

How should I take baclofen?

Take baclofen exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (do no use a kitchen spoon).

Call your doctor if your muscle symptoms do not improve, or if they get worse.

Do not stop using this medicine suddenly, or you could have unpleasant withdrawal symptoms such as hallucinations or a seizure. Ask your doctor how to safely stop using this medicine.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include muscle weakness, vomiting, drowsiness, dilated or pinpoint pupils, weak or shallow breathing, seizure, or coma.

What should I avoid while taking baclofen?

Do not use baclofen at a time when you need muscle tone for safe balance and movement during certain activities. In some situations, it may be dangerous for you to have reduced muscle tone.

Drinking alcohol with this medicine can cause side effects.

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Baclofen side effects

Get emergency medical help if you have signs of an allergic reaction to baclofen: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • weak or shallow breathing;

  • confusion, hallucinations; or

  • a seizure (convulsions).

Common baclofen side effects may include:

  • drowsiness, dizziness, weakness, tired feeling;

  • headache;

  • sleep problems (insomnia);

  • nausea, constipation; or

  • urinating more often than usual.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect baclofen?

Taking baclofen with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death.

Tell your physician if you are taking any of the following medications:

ul>

  • Opioid medications
  • Sleeping pills
  • Muscle relaxers
  • Medication for depression, anxiety, or bipolar disorder
  • Seizure medication
  • Blood pressure medication
  • Other drugs may interact with baclofen, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

    Further information

    Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use baclofen only for the indication prescribed.

    Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

    Copyright 1996-2020 Cerner Multum, Inc. Version: 7.01.

    Medical Disclaimer

    More about baclofen

    • Side Effects
    • During Pregnancy or Breastfeeding
    • Dosage Information
    • Patient Tips
    • Drug Images
    • Drug Interactions
    • Compare Alternatives
    • Support Group
    • Pricing & Coupons
    • 313 Reviews
    • Drug class: skeletal muscle relaxants
    • FDA Alerts (3)

    Consumer resources

    • Baclofen Tablets
    • Baclofen Intrathecal Injection
    • Baclofen Oral Solution
    • Baclofen (Advanced Reading)
    • Baclofen Intrathecal (Advanced Reading)

    Other brands: Lioresal, Gablofen, Ozobax

    Professional resources

    • Baclofen (AHFS Monograph)
    • … +3 more

    Related treatment guides

    • Cervical Dystonia
    • Alcohol Withdrawal
    • Cerebral Spasticity
    • Chronic Spasticity
    • … +13 more

    PMC

    DISCUSSION

    Baclofen is a centrally acting skeletal muscle relaxant. A selective gamma-amino butyric acidB(GABAB) agonist, it is used widely used in the treatment of spastic disorders. Baclofen in high doses can remarkably produce a state of indifference toward alcohol. It has shown preclinical and clinical evidence in treating tobacco addiction as well. Baclofen quietens the dopaminergic afferents and indirectly tackles the dopamine surge occurring in the ventral striatal regions due to drug abuse. Evidence-based reports state that chronic administration of baclofen reduces the drug-motivated behaviors in opiate, amphetamine, and cocaine abuse. The commendable decrease in the reinforcing properties of nicotine at a low dose of 20 mg 4 times daily makes it a promising drug in the pipeline for smoking cessation.

    Despite being in clinical use for several years, reports on baclofen abuse are less. The paradoxical euphoria produced by baclofen maps to the abuse potential of this drug. The role of gamma-hydroxybutyrate (GHB) receptor in producing euphoria has to be evaluated. Winter opined that of all the GABAergic ligands studied, baclofen tended to occasion the greatest GHB-appropriate responding (70%). Kamal et al. described a GHB-dependent patient, who co-ingested baclofen with GHB and developed a rapid coma, bradypnea, and hypotonia. This patient “X” exhibited dependence on a high dose of baclofen (600 mg/day) owing to its euphoric effect. Psychological and physical dependence characterized by craving and withdrawal effects temporally correlate with baclofen withdrawal. de Beaurepaire discusses a patient with baclofen use 630 mg/day (against medical advice) for a month and a half until he developed acute delirium, agitation, and facial hematoma. He also discusses a patient who had stimulant effect with 310 mg/day making him placid and less aggressive.

    Doses higher than 300 mg/day are useful clinically in alcoholics with mostly benign side effects. The side effects of baclofen are often transient. It includes sedation, dizziness, weakness, nausea, headache, skin rash, itching, shortness of breath, problems in micturition, bowel changes, irregular heartbeat, and chest pain. Massive overdosage is characterized by central depression, hypothermia, hypoventilation, flaccidity, bradycardia, and hypotension. Abrupt cessation can result in mild muscle spasms to life-threatening seizures and multi-system organ failure. Tapering is necessary to avoid baclofen withdrawal. The patient “X” developed insomnia, irritability, anger outburst, and tremor of hand even when the dose was slowly tapered and stopped.

    Lile et al. evaluated the separate and combined effects of baclofen 25/50 mg and Δ9-tetrahydrocannabinol (THC) and opined that large dose baclofen alone occasioned Δ9-THC-appropriate responding. Increased drug liking and relaxation following baclofen administration in smokers have been reported. An acute dose of 20 mg of baclofen can decrease the palatability of cigarettes. The patient might have substituted his cigarette with baclofen resulting in massive overdose of the drug. Although its ready availability and good tolerance can make it an effective smoking cessation aid, the same can increase its chances of being used as a drug of abuse.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.

    What Is Baclofen 10mg Street Price?

    Of course, you can buy Baclofen from some unknown dealer on the street. However, it is much better to order generic Baclofen from Indian pharmacy and get the 100% quality drug. You can buy Baclofen from as low as $0.3 per pill online.

    What Is Baclofen?

    Baclofen is a GABA-like drug, which has been used for decades as a treatment for spasticity. It has some recreational effects that are similar to Phenibut. Research has also explored baclofen for alcohol dependence and other substance use disorders.

    Among the positive effects are muscle relaxation, euphoria, sedation, pain relief, and anxiety reduction. The negative effects may include respiratory depression, dizziness, drowsiness, memory loss, and confusion.

    It has long been used for spasticity originating with various.conditions. This remains its greatest application, though, other potential uses for the drug have appeared.

    In addition to oral use, it may also be taken intrathecally. It allows it to be delivered more directly to the spine. A lower dose can be used preventing some of the negative effects.

    The non-medical effects are generally compared to those of GHB. It tends to produce less euphoria than GHB and is believed to have a lower abuse potential in medical settings.

    Baclofen is similar to Phenibut in its effects, however, it appears to provide less anxiety reduction, is more sedating and has a faster onset. |Given this, it’s a fairly subtle drug capable of providing some anxiety reduction, muscle relaxation, and sedation.

    Baclofen has been studied as a treatment for alcohol dependence since it may be able to function as both an antique craving drug and a replacement. There is conflicting research in this area and it is possible the required dose is in the hundreds of milligrams per day for which we definitely need more research.

    It appears Baclofen may reduce tremor, anxiety, agitation, sweating and other alcohol withdrawal symptoms. The drug may also help people reduce their drinking or maintain abstinence.

    Less data exists regarding the effect on other dependencies. It might have more generalized anti-addiction effects due to antagonizing dopamine activity associated with addictive drugs and activities.

    Orally the drug lasts for 3 to 6 hours and it begins working in 15 to 45 minutes. Doses above the strong range may last significantly longer.

    Baclofen exists as an R and S isomer with R Baclofen being far more potent. It’s a GABA analog that is very close in structure to Phenibut. The drug’s primary action is a GABA-B agonist, which means it can inhibit excitatory neurotransmitter activity. That action is responsible for its core effects.

    Baclofen is normally used at 30 to 75 milligrams per day for spasticity. And that dose is split up throughout the day. A light dose is 10 to 20 milligrams; a common dose is 20 to 50 milligrams; a strong dose is 50 to 75 milligrams.

    Baclofen History

    Heinrich Keberle, a chemist at Sibugay, synthesized the drug in 1962. It was originally developed as a treatment for epilepsy, but it didn’t end up being used in that way. Baclofen was instead introduced in the late 1960s as a treatment for spasticity. Studies around this time found it was quite effective. In these studies, it was often compared to diazepam and had a similar or sometimes superior efficacy.

    The first overdose appears to have been reported in 1972. Baclofen tumors were identified in 1975. Later that decade, there were multiple hospitalizations due to people experimenting with the drug. Those cases involved diversion from medical use.

    Baclofen was approved by the FDA in 1977 for spasticity associated with conditions like multiple sclerosis. Some of the earliest research on the GABA-B receptor involved the drug. Norman Bowery, the discoverer of GABA B, found in 1980 that Baclofen operated like GABA in providing effects, which could not be attributed to the already identified GABA receptor. Bowery also found our Baclofen was more active enantiomer.

    Intrathecal administration of the drug appeared in the mid-1980s allowing patients to avoid some of the negative effects while potentially receiving more relief.

    Currently, Baclofen is widely prescribed for spasticity and interest has grown in its potential application in many other conditions. There is also some recreational use of the drug due to its Phenabut-like effects.

    Baclofen is prescription-only rather than a controlled drug in the US. It is usually prescription only or entirely uncontrolled in other countries.

    Baclofen overdose

    Common doses generally have few negative effects beyond stomach upset and tiredness. Overdoses can be much more problematic and severe overdoses can be fatal. A classic overdose generally occurs with over 200 mg, but even 100mg can bring some negative effects. Once you reach 100mg, coma, confusion, delirium, respiratory depression and seizures become potential outcomes. It’s also possible to have bradycardia or tachycardia, hypotension or hypertension, and meiosis or mitosis.

    There have occasionally been reports of visual effects, but those primarily appear in very large overdoses and in withdrawal. Overdoses are not only problematic because of their effects, but because the duration of action may extend to 24 hours or more. There can be multiple peaks in Baclofen’s effects during this time. And it’s possible to have CNS depression that lasts beyond the presence of large serum concentrations.

    There are a number of cases where more than 1000mg has been used. Those cases usually result in mechanical ventilation and extended coma. Though, people tend to be fine upon leaving the hospital. Of course, in the absence of medical attention, those overdoses would have been fatal. Cases of coma lasting three or more days do exist and they’ve occasionally mimicked brain death.

    In one report the prognosis was grim enough for an organ transplant process to be set in motion. However, the patient did come out of the coma. When coming out of a Baclofen coma, it is common for there to be agitation, hyperthermia, delirium, tachycardia, hallucinations and other issues.

    Those problems sometimes necessitate a prolonged stay in the hospital. While overdose is managed by medical professionals usually result in survival, some deaths have been recorded. Some of those deaths occurred with 1 to 2.5 grams, however, even 200 to 300 mg could be very problematic in the absence of help.

    Seizures are an established concern with the drug and our particular concern in those with a history of seizures. If you have impaired renal function, overdoses can occur with lower amounts including at normal medical doses.

    Baclofen withdrawal and addiction

    Tolerance to Baclofen does build, but it seems to do so fairly slow over a period of weeks rather than a few days. Tolerance to the pain-relieving and sedating effects you build faster. Withdrawal can be dangerous and it may include issues like seizures, hallucinations, insomnia, agitation, delirium, tachycardia and hyperthermia.

    Abruptly stopping the drug is more of a concern if someone has been taking the drug for months. Some of the risky combinations include other depressants like alcohol and benzodiazepine.

    Read: The $1 tool that might curb the overdose epidemic

    By examining the National Poison Data System, which collects reports of poisonings around the United States, Kimberly Reynolds, a researcher at the University of Pittsburgh, and her co-authors recently found that people are increasingly using both gabapentin and baclofen to either get high or attempt suicide. From 2013 to 2017, people tried to commit suicide using gabapentin nearly 42,000 times, and thousands more abused or misused the substance. In most cases—nearly 70 percent—the poisoned individuals took a combination of gabapentin and other drugs. Meanwhile, the majority of the poison cases involving baclofen were suicide attempts. “It’s rare, but overdose from large quantities of gabapentin or baclofen can be fatal,” Reynolds told me via email.

    In isolation, gabapentin isn’t necessarily dangerous. Many chronic-pain patients rely on it to maintain functionality. But when used in high doses, or in combination with opioids or benzodiazepines, it can be risky. “People who take high-dose gabapentin for months or years on end often do develop tolerance”—that is, the need to take more and more of the drug to achieve the same effect, says Arthur Robin Williams, an assistant professor at Columbia University who was not involved in Reynolds’s study. When patients stop taking these drugs abruptly, they can experience withdrawal symptoms. They often start taking them again in order to feel “better,” when in reality their improved feeling is simply the withdrawal symptoms abating.

    Reynolds’s study and others suggest that doctors’ long struggle to find a safe, reliable treatment for chronic pain is far from over. Just as opioids were used to get recreationally high and potentially cause overdose, it appears that their replacements sometimes are as well. In fact, Reynolds and her co-authors write that people often take gabapentin and baclofen in combination with benzodiazepines, such as Xanax, or with opioids, in order to increase their intoxicating effect.

    Gabapentin is often prescribed in combination with opioids, in order to enhance their pain-relieving potential, and this combo can be especially dangerous. Gabapentin is sedating, and it increases the risk of overdose death by compounding opioids’ sedating effect. In a 2017 study, David Juurlink, a scientist at the Sunnybrook Research Institute, in Toronto, and his co-authors found that among patients who take prescription opioids, those who die of overdose are more likely to have also been prescribed gabapentin or a version of it, pregabalin, than those who don’t die.

    Reynolds and others say patients who are prescribed drugs like gabapentin and baclofen should be screened for substance-abuse disorders, mood disorders, and suicidal ideation. And patients who are taking gabapentin should avoid mixing it with other drugs, especially depressants such as alcohol and opioids. Some states have started treating gabapentin as a serious drug, rather than the chronic-pain equivalent of gummy vitamins. Kentucky, Tennessee, and Michigan have reclassified gabapentin as a Schedule 5 controlled substance. Several other states have mandated the reporting of gabapentin prescriptions to prescription-drug-monitoring databases. (Baclofen, however, remains unscheduled.)

    1. 1.

      Loftus H, Wright A. Potential misuse of pregabalin and gabapentin. BMJ. 2014;348:g1290.

      • PubMed
      • Article
      • Google Scholar
    2. 2.

      Grosshans M, Lemenager T, Vollmert C, Kaemmerer N, Schreiner R, Mutschler J, Wagner X, Kiefer F, Hermann D. Pregabalin abuse among opiate addicted patients. Eur J Clin Pharmacol. 2013;. doi:10.1007/s00228-013-1578-5.

      • PubMed
      • Google Scholar
    3. 3.

      Spigset O, Westin AA. Detection times of pregabalin in urine after illicit use: when should a positive specimen be considered a new intake? Ther Drug Monitor. 2013;35:137–40.

      • CAS
      • Article
      • Google Scholar
    4. 4.

      Kruszewsky SP, Paczinskly RP, Kahn DA. Gabapentin-induced delirium and dependence. J Psychiatr Pract. 2009;15:314–9.

      • Article
      • Google Scholar
    5. 5.

      Canadian Agency for Drugs and Technologies in Health (CADTH). Abuse and misuse potential of pregabalin: a review of the clinical evidence; Context and policy issues; 2012. (Accessed 20 Feb 2014).

    6. 6.

      British National Formulary, 2014. Gabapentin. http://www.medicinescomplete.com/mc/bnf/current/PHP2930-gabapentin.htm?q=gabapentin&t=search&ss=text&p=1#_hit (Accessed 1 Apr 2014).

    7. 7.

      Piskorska B, Miziak B, Czuczwar SJ, Borowicz KK. Safety issues around misuse of antiepileptics. Expert Opin Drug Saf. 2013;12:647–57.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    8. 8.

      Spence D. Bad medicine: gabapentin and pregabalin. BMJ. 2013;347:f6747.

      • PubMed
      • Article
      • Google Scholar
    9. 9.

      Persheim MS, Helland A, Spigset O, Slørdal L. Potentially addictive drugs on reimbursable prescription for chronic severe pain. Tidsskr Nor Laegeforen. 2013;22(133):150–4.

      • Article
      • Google Scholar
    10. 10.

      Schifano F, D’Offizi S, Piccione M, Corazza O, Deluca P, Davey Z, Di Melchiorre G, Di Furia L, Farré M, Flesland L, Mannonen M, Majava A, Pagani S, Peltoniemi T, Siemann H, Skutle A, Torrens M, Pezzolesi C, van der Kreeft P, Scherbaum N. Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data. Psychother Psychosom. 2011;80:118–22.

      • PubMed
      • Article
      • Google Scholar
    11. 11.

      Corkery J, Claridge H, Loi B, Goodair C, Schifano F. Drug related deaths in the UK; annual report 2013. London: International Centre for Drug Policy, St George’s, University of London; 2014. ISBN: 978-1-897778-9-2.

    12. 12.

      Wills B, Reynolds P, Chu E, Murphy C, Cumpston K, Stromberg P, Rose R. Clinical outcomes in newer anticonvulsant overdose: a Poison Center observational study. J Med Toxicol. 2014 (Epub ahead of print).

    13. 13.

      Priez-Barallon C, Carlier J, Boyer B, Benslima M, Fanton L, Mazoyer C, Gaillard Y. Quantification of pregabalin using hydrophilic interaction HPLC-high-resolution MS in postmortem human samples: eighteen case reports. J Anal Toxicol. 2014;38:143–8.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    14. 14.

      Vuori E. Finland: new development in drug related deaths; 2009. (Accessed 1 Apr 2014).

    15. 15.

      Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010;49:661–9.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    16. 16.

      Gajraj N. Pregabalin: its pharmacology and use in pain management. Anesth Analg. 2007;105:1805–15.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    17. 17.

      Martinotti G, Lupi M, Sarchione F, Santacroce R, Salone A, De Berardis D, Serroni N, Cavuto M, Signorelli M, Aguglia E, Valchera A, Iasevoli F, Di Giannantonio M. The potential of pregabalin in neurology, psychiatry and addiction: a qualitative overview. Curr Pharm Des. 2013;19:6367–74.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    18. 18.

      Stahl SM. Anticonvulsants as anxiolytics, part 2: pregabalin and gabapentin as alpha(2)delta ligands at voltage-gated calcium channels. J Clin Psychiatry. 2004;65:460–1.

      • PubMed
      • Article
      • Google Scholar
    19. 19.

      de Guglielmo G, Cippitelli A, Somaini L, Gerra G, Li H, Stopponi S, Ubaldi M, Kallupi M, Ciccocioppo R. Pregabalin reduces cocaine self-administration and relapse to cocaine seeking in the rat. Addict Biol. 2012;18:644–53.

      • PubMed
      • Article
      • Google Scholar
    20. 20.

      Richerson GB, Wu Y. Dynamic equilibrium of neurotransmitter transporters: not just for reuptake anymore. J Neurophysiol. 2003;90:1363–74.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    21. 21.

      Taylor CP, Gee NS, Su T-Z. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res. 1998;29:233–49.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    22. 22.

      Cai K, Nanga RP, Lamprou L, Schinstine C, Elliott M, Hariharan H, Reddy R, Epperson CN. The impact of gabapentin administration on brain GABA and glutamate concentrations: a 7T ¹H-MRS study. Neuropsychopharmacology. 2012;37:2764–71.

      • CAS
      • PubMed Central
      • PubMed
      • Article
      • Google Scholar
    23. 23.

      Bucur M, Jeczmien P. Pregabalin and libido. Open Neuropsychopharmacol J. 2011;. doi:10.2174/1876523801104010008.

      • Google Scholar
    24. 24.

      Badgaiyan RD. A novel perspective on dopaminergic processing of human addiction. J Alcohol Drug Depend. 2013;1(1).

    25. 25.

      Modelon H, Frauger E, Laurenceau D, Thirion X, Mallaret M, Micallef J, ŕeseau des CEIP. Psychotropic drug addiction: consumption study of specific population by the survey OPPIDUM 2004 from the CEIP network. Therapie. 2007;62:337–46.

      • PubMed
      • Article
      • Google Scholar
    26. 26.

      Kapil V, Green JL, Le Lait C, Wood DM, Dargan PI. Misuse of the GABA-analogues baclofen, gabapentin and pregabalin in the United Kingdom. Br J Clin Pharmacol. 2013. doi:10.1111/bcp.12277

    27. 27.

      Jones D, Sorkin L. Systemic gabapentin and 3-isobutyl-aminobutyric acid block secondary hyperalgesia. Brain Res. 1998;810:93–9.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    28. 28.

      Brighton and Hove Clinical Commissioning Group. Pregabalin prescribing policy; 2012. (Accessed 1 Apr 2014).

    29. 29.

      Schwan S, Sundström A, Stjernberg E, Hallberg E, Hallberg P. A signal for an abuse liability for pregabalin: results from the Swedish spontaneous adverse drug reaction reporting system. Eur J Clin Pharmacol. 2010;66:947–53.

      • PubMed
      • Article
      • Google Scholar
    30. 30.

      Zacny JP, Paice JA, Coalson DW. Subjective, psychomotor, and physiological effects of pregabalin alone and in combination with oxycodone in healthy volunteers. Pharmacol Biochem Behav. 2012;100:560–5.

      • CAS
      • PubMed Central
      • PubMed
      • Article
      • Google Scholar
    31. 31.

      Bodén R, Wettermark B, Brandt L, Kieler H. Factors associated with pregabalin dispensing at higher than the approved maximum dose. Eur J Clin Pharmacol. 2014;70:197–204.

      • PubMed
      • Article
      • Google Scholar
    32. 32.

      Dyrkorn R, Reimers A, Johannessen L, Spigset O. Do urine tests for drugs of abuse cover the substances of interest? Tidsskr Nor Laegeforen. 2011;131:570–2.

      • PubMed
      • Article
      • Google Scholar
    33. 33.

      Baird CR, Fox P, Colvin LA. Gabapentinoid abuse in order to potentiate the effect of methadone: a survey among substance misusers. Eur Addict Res. 2013;20:115–8.

      • PubMed
      • Article
      • Google Scholar
    34. 34.

      Smith BH, Higgins C, Baldacchino A, Kidd B, Bannister J. Substance misuse of gabapentin. Br J Gen Pract. 2012;. doi:10.3399/bjgp12X653516.

      • Google Scholar
    35. 35.

      Carrus D, Schifano F. Pregabalin misuse related issues; intake of large dosages, drug smoking allegations, and association with myositis: two case reports. J Clin Psychopharmacol. 2012;32:839–40.

      • PubMed
      • Article
      • Google Scholar
    36. 36.

      Di Nicola M, Martinotti G, Tedeschi D, Frustaci A, Mazza M, Sarchiapone M, Pozzi G, Bria P, Janiri L. Pregabalin in outpatient detoxification of subjects with mild-to-moderate alcohol withdrawal syndrome. Hum Psychopharmacol. 2010;25:268–75.

      • PubMed
      • Article
      • Google Scholar
    37. 37.

      Martinotti G, Di Nicola M, Tedeschi D, Andreoli S, Reina D, Pomponi M, Mazza M, Romanelli R, Moroni N, De Filippis R, Di Giannantonio M, Pozzi G, Bria P, Janiri L. Pregabalin versus naltrexone in alcohol dependence: a randomised, double-blind, comparison trial. J Psychopharmacol. 2010;24:1367–74.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    38. 38.

      Guglielmo R, Martinotti G, Clerici M, Janiri L. Pregabalin for alcohol dependence: a critical review of the literature. Adv Ther. 2012;29:947–57.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    39. 39.

      Bramness JG, Sandvik P, Engeland A, Skurtveit S. Does pregabalin (Lyrica®) help patients reduce their use of benzodiazepines? A comparison with gabapentin using the Norwegian Prescription Database. Basic Clin Pharmacol Toxicol. 2010;107:883–6.

      • CAS
      • PubMed
      • Google Scholar
    40. 40.

      Kämmerer N, Lemenager T, Grosshans M, Kiefer F, Hermann D. Pregabalin for the reduction of opiate withdrawal symptoms. Psychiatr Prax. 2012;39:351–2.

      • PubMed
      • Article
      • Google Scholar
    41. 41.

      Salehi M, Kheirabadi GR, Maracy MR, Ranjkesh M. Importance of gabapentin dose in treatment of opioid withdrawal. J Clin Psychopharmacol. 2011;31:593–6.

      • CAS
      • PubMed
      • Article
      • Google Scholar
    42. 42.

      Mason BJ, Crean R, Goodell V, Light JM, Quello S, Shadan F, Buffkins K, Kyle M, Adusumalli M, Begovic A, Rao S. A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology. 2012;37:1689–98.

      • CAS
      • PubMed Central
      • PubMed
      • Article
      • Google Scholar
    43. 43.

      Olive MF, Cleva RM, Kalivas PW, Malcolm RJ. Glutamatergic medications for the treatment of drug and behavioral addictions. Pharmacol Biochem Behav. 2012;100:801–10.

      • CAS
      • PubMed Central
      • PubMed
      • Article
      • Google Scholar
    44. 44.

      Myrick H, Malcolm R, Randall PK, Boyle E, Anton RF, Becker HC, Randall CL. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009;33:1582–8.

      • CAS
      • PubMed Central
      • PubMed
      • Article
      • Google Scholar
    45. 45.

      Howland RH. Gabapentin; can it be misused? J Psychosocial Nurs. 2014;52:12–5.

      • Google Scholar
    46. 46.

      Sweet AD. Pregabalin abuse and the risks associated for patients with a previous history of substance misuse. J Addict Res Ther. 2013;4:e116.

      • Google Scholar
    47. 47.

      Grosshans M, Mutschler J, Hermann D, Klein O, Dressing H, Kiefer F, Mann K. Pregabalin abuse, dependence, and withdrawal: a case report. Am J Psychiatry. 2010;167:869.

      • PubMed
      • Article
      • Google Scholar
    48. 48.

      Filipetto FA, Zipp CP, Coren JS. Potential for pregabalin abuse or diversion after past drug-seeking behavior. J Am Osteopath Assoc. 2010;110:605–7.

      • PubMed
      • Google Scholar
    49. 49.

      Ghodse H, Corkery J, Claridge H, Goodair C, Schifano F. Drug-related deaths in the UK: annual report 2012. Drug-related deaths reported by coroners in England, Wales, Northern Ireland, Guernsey, Jersey and the Isle of Man; police forces in Scotland; & the Northern Ireland Statistics and Research Agency: annual report January-December 2011. 28 February. London: International Centre for Drug Policy, St George’s University of London; 2013.

    50. 50.

      Anonymous. Gabapentin and pregabalin: abuse and addiction. Prescrire Int. 2012;21:152–4.

    Sir,

    Baclofen is a centrally acting skeletal muscle relaxant due to its selective agonism on GABAB receptor. It is useful for alleviation of signs and symptoms of skeletal muscle spasticity, particularly in patient suffering from multiple sclerosis, spinal, and cerebral disorders. In psychiatry, it is used as an anti-craving agent as it tackles dopamine surge in ventral tegmentum areas. Baclofen has multiple side effect such as drowsiness, sedation, dizziness, fatigue, respiratory depression, and coma. It is not mentioned in the literature that baclofen can also cause severe back pain which is a paradoxical phenomenon where baclofen is prescribed to relieve back spasm.

    A 30-year-old married man a farmer who was diagnosed to have alcohol dependence syndrome for the last 10 years presently abstinent for the past 3 months. He was prescribed baclofen 60 mg 2 months ago as an anti-craving agent. In the first 1 month of abstinent, the patient never complained of anybody ache. After 1 week of starting baclofen, patient started complaining severe back pain which was could be due to alcohol-induced neuropathy or myelopathy. However, all the investigations including renal functional test, liver function test, and serum electrolytes were found to be within normal limits. Neurological assessment was found to be within the normal limit. The onset of back pain was temporally related to use of baclofen. Hence, we gradually tapered and stopped the baclofen. Following 2 weeks of stopping baclofen, the patient got relieved of back pain without any other intervention.

    Baclofen is quite a safe and useful drug for multiple neuropsychiatric disorders. Where baclofen relaxes the stiff muscles and relieves the pain, baclofen producing muscular pain is a surprisingly rare phenomenon. Patients who are involved in strenuous exercise needs their lower body muscle to be contracted at the time of hard word. The patient described above was a farmer who used to work in the fields for prolonged period. The baclofen-induced relaxed lower body muscle may not support the weight of the upper body during work which could be the cause of severe back pain however, this is just an assumption. Research is much warranted in the patients who complain of back pain following baclofen use.

    Nil.

    There are no conflicts of interest.

    About baclofen

    Type of medicine Skeletal muscle relaxant
    Used for To relieve muscle spasms
    Also called Lyflex®; Lioresal®
    Available as Tablets, oral liquid and injection

    Long-term (chronic) muscle stiffness can occur in multiple sclerosis and in conditions where there has been damage to nerves that supply muscles. In these conditions, the muscles shorten (contract) tightly, and can then become stiff and harder to use. This is called muscle spasticity.

    Baclofen works by relaxing the muscles, which reduces pain and discomfort.

    Before taking baclofen

    Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking baclofen it is important that your doctor or pharmacist knows:

    • If you are pregnant, trying for a baby or breastfeeding.
    • If you have ever had a stomach ulcer.
    • If you have kidney or liver problems, or an ‘overactive’ bladder.
    • If you have ever had a stroke, or if the blood vessels to your brain are narrowed by cerebrovascular disease.
    • If you have high blood pressure (hypertension).
    • If you have epilepsy, Parkinson’s disease or diabetes.
    • If you have any mental health problems.
    • If you have problems with your breathing.
    • If you have ever had problems with drug or alcohol misuse.
    • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
    • If you have ever had an allergic reaction to a medicine.

    How to take baclofen

    • Before you start this treatment, read the manufacturer’s printed information leaflet from inside your pack. The leaflet will give you more information about baclofen and a full list of side-effects which you may experience from taking it.
    • When starting this treatment, your doctor will give you a small dose (usually half a tablet three times daily) and then gradually increase your dose every three days or so. This allows your doctor to make sure that you have the dose that helps your condition and avoids any unwanted symptoms.
    • Take the tablets exactly as your doctor tells you to. Your dose will be on the label of the pack to remind you.
    • When baclofen is prescribed for a child, it is likely that a liquid medicine will be supplied. Check the directions on the label carefully, as the dose will depend upon their body weight.
    • Take baclofen with a snack or just after eating a meal.
    • Try to take your doses at the same times of day each day, as this will help you to remember to take them. If you do forget to take a dose, skip the missed dose but remember to take your next dose when it is due. Do not take two doses together to make up for a forgotten dose.

    Getting the most from your treatment

    • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
    • Baclofen may cause drowsiness and eyesight problems. If this happens, do not drive and do not use tools or machines until you feel better.
    • If your muscle spasms increase or if you have difficulty doing things because you feel your muscles have become weak, let your doctor know about this, as your dose may need adjusting.
    • It is recommended that you do not drink alcohol while you are on baclofen. This is because it increases the chance that you will experience side-effects such as feeling sleepy or dizzy.
    • Treatment with baclofen is usually long-term, so keep taking these tablets unless your doctor tells you otherwise. Suddenly stopping treatment can cause problems, so your doctor is likely to want you to reduce your dose gradually if this is necessary.
    • If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
    • If you buy any medicines, check with a pharmacist that they are safe to take with your other medicines.

    Can baclofen cause problems?

    Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with baclofen. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

    Common baclofen side-effects What can I do if I experience this?
    Feeling sleepy, tired, dizzy or weak If this happens, do not drive and do not use tools or machines
    Feeling sick (nausea), upset stomach or loose, watery stools (diarrhoea) Drink plenty of water and stick to simple foods – avoid rich or spicy meals
    Headache Drink plenty of water and ask a pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know
    Dry mouth Try chewing sugar-free gum or sucking sugar-free sweets
    Mobility problems, eyesight problems, breathing difficulties, aching muscles, sleeping difficulties, mood changes, confusion, needing to pass urine more often, feeling shaky or faint, increased sweating, and rash If any of these become troublesome, discuss them with your doctor

    If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

    How to store baclofen

    • Keep all medicines out of the reach and sight of children.
    • Store in a cool, dry place, away from direct heat and light.

    Important information about all medicines

    Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

    This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

    Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

    If you have any questions about this medicine ask your pharmacist.

    About the author

    Leave a Reply

    Your email address will not be published. Required fields are marked *