Baclofen is a drug used to treat muscle spasticity and is similar to the neurotransmitter GABA. It is currently being researched for its potential to treat addiction and opioid withdrawal. But baclofen also has a potential of abuse and doesn’t come without side effects. Read on to learn about the uses, risks, and dosage of baclofen.
What is Baclofen?
Baclofen is a medication used to treat muscle spasticity or stiffness, especially in people with Multiple Sclerosis. It is also used to relieve pain in people with spinal cord injuries. Its structure is very similar to the neurotransmitter GABA, which calms the nervous system [R].
Baclofen first synthesized in the 1960s in search for an anti-seizure drug. It didn’t work well for this indication, though, but it turned out to be effective at reducing muscle spasticity. It was first sold under the brand name Lioresal in the 1970s, under which it’s still known today [R].
There are 3 ways to administer baclofen [R]:
- As a cream, when it is absorbed through the skin
- As oral tablets
- As injections directly into the spinal fluid (intrathecally), using an implanted pump. These pumps are implanted only in people with spinal cord damage who need long-term treatment.
Baclofen is used unofficially to treat substance abuse. More and more people are asking their doctors for a baclofen prescription to combat addiction, but there are no clinical trials with convincing evidence. Researchers in Amsterdam were recently surprised to receive half-a-million euros from an anonymous Dutch donor to conduct a rigorous placebo-controlled study of the drug for treating addiction [R].
Is Baclofen a Narcotic?
By definition, baclofen is not a narcotic since it’s not an opioid drug. Baclofen does fall under the broader category of ‘Central Nervous System Depressants’, drugs that can cause sedation and have a potential for abuse [R, R].
Mechanism of Action
Baclofen has a structure and function similar to the neurotransmitter GABA. GABA acts to reduce activity in the brain, which is why it’s known as a “calming” substance. Baclofen can activate specific GABA B receptors, which are important for many psychiatric disorders and brain diseases. GABA activation can also reduce pain [R, R].
All GABA activity in the brain and nerves is “inhibitory”, it blocks the release of other neurotransmitters brain cells use to communicate. By acting on GABA, baclofen blocks the overactivation of nerves that can trigger spasms, pain, brain damage, and mood changes [R, R].
Much more is known about the effects of baclofen on pain and muscle spasms than on mood and addictive behavior [R].
Baclofen Reduces Muscle Spasticity
1) Baclofen Is a Muscle Relaxant
Spasticity is caused when muscles are continuously contracting. It leads to tightness and stiffness in the long run and can interfere with everyday life. Baclofen is a muscle relaxant that helps relieve these spasms.
Note: Muscle spasticity is often a consequence of an underlying disease, such as Multiple Sclerosis, stroke, cerebral palsy, or inherited neurological disorders (such as spastic paraplegia).
In a clinical trial of 60 children with cerebral palsy, oral baclofen reduced spasticity by 30% [R].
In two long-term trials of 35 cerebral palsy children in total, baclofen spinal cord injections reduced spasticity over 5 years by about 50%. The injections also improved walking ability, reducing the need for supportive walking aids [R, R].
Multiple Sclerosis (MS)
In a long-term clinical trial of 28 people with Multiple Sclerosis (MS), baclofen spinal cord injections reduced spasticity, improved the quality of life and functional independence [R].
However, in a trial of 20 MS patients, oral baclofen didn’t have an effect on spasticity [R].
Brain Injury & Stroke
Baclofen spinal cord injections helped with rehabilitation and reduced spasticity in a large trial of 250 children with brain injuries (1-14 years old). Baclofen injections were offered only after all other previous treatments didn’t help [R].
In another trial of 94 stroke patients with spasms, baclofen injections reduced spasticity and improved daily functioning and the quality of life over 1 year [R].
In 10 people, baclofen injections improved rehabilitation post-stroke, increasing mobility and walking speed [R].
Baclofen injections are more effective than oral baclofen for reducing spasms and improving rehabilitation after brain injuries, including stroke and concussions.
In a trial of 35 people with brain injury, oral baclofen only reduced spasticity in the lower part of the body but had no effect on the upper part [R].
In a clinical trial of 48 people, baclofen spinal cord injections were more effective for post-stroke muscle spasms than oral baclofen or other oral drugs (tizanidine, diazepam, or dantrolene) [R].
Hereditary Neurological & Genetic Disorders
In a 2-year study of 14 people with a hereditary neurological disorder (hereditary spastic paraplegia), baclofen spinal cord injections reduced spasticity by 70% and improved walking ability by 30% [R, R].
Baclofen injections reduced spasticity in a case study on 2 patients with a rare genetic disorder that causes neurological problems (called Sjögren-Larsson syndrome) [R].
2) Baclofen Helps with Movement Disorders
In a case study of a man with a rare movement disorder (hemiballismus), baclofen spinal cord injections improve symptoms. Baclofen reduced the number of uncontrolled movement episodes from 10-12 per hour to only 3 episodes per day [R].
Antipsychotic drugs used long-term can cause a movement disorder known as ‘tardive dyskinesia’. Oral baclofen improved symptoms in 15 out of 20 women with tardive dyskinesia in one clinical trial in a study from the 70s. Other, more effective drugs have been approved for tardive dyskinesia in the meantime (valbenazine) [R].
Baclofen May Help with Addictions
Recently, doctors and researchers realized that Baclofen may help combat addiction. Studies were carried out in people with alcohol dependence, in alcohol withdrawal, opioid withdrawal, and even in those who suffer from binge eating disorder.
More studies are currently being conducted about its addiction-reducing potential.
3) Alcohol Dependence
In a 2-year study on 100 alcohol-dependent people, 92% felt reduced alcohol craving from taking oral baclofen [R].
4) Alcohol Withdrawal
In a 10-day study on 37 people experiencing alcohol withdrawal syndrome, oral baclofen reduced physical symptoms similar to diazepam [R].
Oral baclofen reduced the need for benzodiazepines in a 3-day trial on 44 patients with alcohol withdrawal syndrome [R].
But in another study on 60 people, oral baclofen wasn’t as effective at reducing alcohol withdrawal symptoms as another drug (chlordiazepoxide) [R].
5) Opioid Addiction and Withdrawal
Baclofen is emerging as a new drug therapy for people with opioid addiction or going through opioid withdrawal. The studies are still limited.
In 2 recent trials lasting 2-12 weeks on 102 people with opioid addiction, oral baclofen reduced the physical symptoms of opioid withdrawal, and improved mood and mental symptoms. It also slightly reduced craving. Baclofen works by increasing GABA in the brain, which can help with both the addiction and with withdrawal [R, R].
6) Binge Eating Disorder
Binge eating disorder is not a typical “addiction”, but it is the most common eating disorder. People who suffer from it are unable to stop uncontrollably eating large amounts of food.
In one clinical trial of 12 people with binge eating disorder, oral baclofen the frequency of binge eating and food craving after 48 days. Baclofen had the same effect in another trial on 7 women with binge eating disorder and bulimia after 10 weeks. However, it worsened depressive symptoms, caused tiredness, fatigue, and stomach upset [R, R].
Other Baclofen Uses
7) Baclofen Reduces Acid Reflux
Baclofen reduced acid symptoms, reflux frequency and length in an analysis of 9 clinical trials and almost 300 people with no serious adverse effects [R].
8) Baclofen May Help with PTSD
Baclofen reduced PTSD symptoms, anxiety, and depression in 11 out of 14 veterans with combat-related PTSD after 8 weeks in one clinical trial. This effect is probably due to Baclofen’s GABA-enhancing activity [R].
Side Effects and Risks of Baclofen
Fatigue, Sleepiness, and Dry Mouth
Fatigue and sleepiness often occur at the start of oral baclofen treatment, especially if the dosage is increased too quickly, if the initial dose is large, or in older people. These side effects typically go away with time and can be reduced by decreasing the dosage.
These side effects are somewhat reduced with baclofen spinal cord injections. When given directly into the cerebrospinal fluid in the spine, the blood-brain barrier is largely bypassed and the effect localized [R].
However, baclofen injections can still cause drowsiness, weakness in the lower extremities, dizziness, and seizures in some people [R].
Baclofen can cause withdrawal symptoms if suddenly discontinued after long-term use.
Withdrawal symptoms include [R]:
- High fever
- Altered mental status
- Low blood pressure
- Worsening of muscle spasticity
- Muscle rigidity
- In rare cases: serious muscle damage (rhabdomyolysis), multiple organ failure, and death.
Withdrawal symptoms start to appear within a couple of hours to days after stopping the drug. These were reported mostly after discontinuing pumps that deliver baclofen spinal injections.
In a 13-year study on 27 people, 5 baclofen users experienced hallucinations after they suddenly stopped taking the drug [R].
In pregnant women, baclofen can cause withdrawal symptoms in newborn babies that include irritability, high-pitched crying, trembling, increased muscle tone, excessive sucking, disordered sleep, increase in body temperature, uneven discolored patches on the skin, and convulsions sometime after delivery [R].
Baclofen Increases Seizure Risk
In a 3-year study on 99 multiple sclerosis patients, baclofen spinal cord injections increased seizure risk. 7% of patients in the baclofen group experienced seizures compared to only 1% in the control group [R].
Baclofen May Reduce Sexual Function in Men
High baclofen doses (over 200 mg) increase the risk of arrhythmias, delirium, coma, seizures, and ICU or long hospital admissions [R].
In a study of 60 baclofen overdose cases, dosage over 200 mg was linked to serious breathing impairments known as acute respiratory failure [R].
Baclofen and Pregnancy
The safety of baclofen in pregnancy has not been established. Pregnant women should discuss potential baclofen risks with their doctor to determine if baclofen is still needed.
Baclofen use during pregnancy may cause preterm delivery, low birth weight, birth defects and withdrawal in newborn babies [R].
In one case study, the newborn baby of women taking 90 mg oral baclofen during pregnancy had seizures shortly after birth. In another case, a newborn baby experienced feeding difficulties. These are all symptoms of baclofen withdrawal and require special medical treatment with baclofen itself or other drugs [R, R].
Baclofen has a potential for abuse. And although rare, some people become addicted to baclofen, especially with high doses.
In one case study, baclofen initially helped a 36-year-old man with depression and alcohol abstinence. However, he developed baclofen abuse due to its mood-enhancing effects and started to take higher and higher doses of the drug [R].
In one other case, a 29-year-old man on a smoking cessation program was prescribed 20 mg/day of baclofen. But he took 30 times the prescribed dose, which added up to 600 mg/day. He described a sense of wellbeing and pleasure from baclofen and a craving for it. As his baclofen dose was reduced, he experienced insomnia, irritability, anger outbursts, and tremors [R].
Please consult your doctor if you are starting baclofen or think you need dosage adjustments. Baclofen is available as 10 mg and 20 mg oral tablets under the brand name Lioresal.
Doctors are recommended to start their patients on oral baclofen at a low dosage, which should be gradually increased until the desired effect is achieved. Your doctor should maintain the lowest possible dosage needed to achieve the effect.
The typical dosage ranges from 40-80 mg/day, while the maximum dosage should not exceed 80 mg/day.
When stopping baclofen, the dosage should be gradually decreased over 1-2 weeks to avoid withdrawal.
Intrathecal Baclofen (Spinal Cord Injections)
Baclofen injections into the spinal cord (intrathecal) are indicated only in people with severe muscle spasticity from injury or multiple sclerosis who do not respond to oral baclofen [R].
The optimum dosage of intrathecal baclofen will individually vary depending on the disease type, symptoms, severity, side effects, and other factors. Patients are screened to determine if baclofen pumps should be implanted for continuous long-term baclofen infusions. Physicians specially trained for the procedure monitor patients and their dosage [R].
Initially, baclofen is administered in very small doses, which are gradually increased while adverse reactions and clinical response are monitored by the healthcare team. Some people don’t respond to baclofen spinal injections. For those who do respond, daily doses are increased by 5-30% until a suitable maintenance dose is found [R].
The dose administration patterns can vary between individuals and include: simple continuous dosing, variable 24-hour flex dosing, or regularly scheduled administration [R].
Baclofen Drug Interactions
Baclofen can interact with the following drugs [R]:
- Other muscle relaxants
- Parkinson’s Disease drugs
- Anti-seizure drugs
- Antidepressants and lithium
- Drugs for high blood pressure
- Other drugs that affect kidney function, such as ibuprofen
- Opioid drugs for pain relief
- Drugs for insomnia or anxiety
- Antihistamines and sedatives
It’s not recommended to consume alcohol while on baclofen, since this can cause additional sleepiness, dizziness, and may even lead to coma.
Tell your doctor, nurse, or pharmacist about the medication you are taking or were recently taking, including herbal and over-the-counter drugs.
One user started having extreme knee pain and muscle spasms after an injury at work. He didn’t like Norco and switched to baclofen instead. Baclofen worked well for him, helped him move easier and have more energy about half an hour after taking the medication. He experienced a loss of appetite and insomnia from it, though, but still considered the benefits outweigh the risks.
One person has serious spine damage from a car accident. They tried various muscle relaxants to combat severe muscle spasms, but nothing worked except baclofen. They’ve been taking it for 14 years at a dose of 20 mg 3 x day and experienced zero side effects. Baclofen gave them the freedom of walking with smoother movements and very little jerky twitches. The only advice they gave to others was never to just quit taking baclofen after taking it for a while because the muscle spasms will come back, along with increased seizure risk. They also cautioned people from taking more than prescribed and warned about possible serious side effects in the event of an overdose or abuse.
Another user said they’ve been taking baclofen for 2 years to overcome walking problems from a spinal cord injury. Without baclofen, they could not walk. They’re on about 40mg total per day (including 10mg in the middle of the night) and feel thankful for it.
Natural Alternatives & Resources
Baclofen is indicated for severe muscle spasms. But plenty of other options are available if you do not have a condition that requires baclofen use or if you’re looking for additional natural ways to combat muscle spasms, addiction, or pain.
- For a full list of natural muscle relaxants, check out this post.
- CBD oil works especially well for muscle spasms in people with Multiple Sclerosis and may also help relieve pain and combat anxiety.
- If you struggle with opioid addiction or chronic pain, we suggest you read more about ways to naturally increase your opioids.
- For other ways to naturally relieve pain, read this post.
- The supplement NAC may also help fight addiction according to some studies.
- Shilajit is a supplement that had anti-addictive effects in animal studies.