Baclofen alternatives: What can I take instead of baclofen?

In this article:

• Compare baclofen alternatives
• Zanaflex
• Dantrium
• Valium
• Klonopin
• Neurontin
• Natural alternatives
• How to switch meds

In this article

• Compare baclofen alternatives
• Zanaflex
• Dantrium
• Valium
• Klonopin
• Neurontin
• Natural alternatives
• How to switch meds

Baclofen is a prescription medicine that belongs to a group of drugs called muscle relaxants. This medication can be used to manage spasticity associated with multiple sclerosis or spinal cord lesions (which may be caused by spinal cord injury or disease). Spasticity includes stiffness, increased muscle tone, and involuntary muscle contractions. Baclofen allows the body to relax by slowing activity in the nervous system. Baclofen is a generic oral tablet, oral solution (Fleqѕuvy), and oral granules (Lyvispаh). A healthcare professional can also administer this medicine directly into the space within the spinal column that contains cerebrospinal fluid (CSF) with intrathecal solution (Liοrеѕal spinal injection).

RELATED: Baclofen interactions to avoid

While an effective treatment option for some people, baclofen may not be the best and safest option for all people treating spasticity associated with multiple sclerosis or spinal cord lesions. Baclofen is not recommended for older people because of excessive drowsiness. In addition, some people may have to avoid the adverse effects of baclofen, such as confusion, dizziness, drowsiness, muscle weakness, headache, nausea, vomiting, constipation, and dry mouth. Other skeletal muscle relaxants are often used to treat musculoskeletal conditions that cause muscle spasms and muscle pain associated with strains, sprains, and other injuries. Baclofen may be used off-label for these conditions but is not recommended. The muscle relaxants used for these types of conditions typically include cyclobenzaprine (formerly known under the brand name Flexeril), methocarbamol (Robaxin), metaxalone (Skelaxin), chlorzoxazone, orphenadrine, or carisoprodol (Soma).

RELATED: When to take muscle relaxers

What can I take in place of baclofen?

There are other options available to treat spasticity associated with multiple sclerosis or spinal cord lesions that do not improve with baclofen. For both multiple sclerosis and spinal cord injury-related spasticity, physical therapy is the mainstay treatment consisting of strengthening exercises, postural management, and manual stretching. However, anti-spasticity medications are still often needed. Baclofen is usually the first medication used and is most common. Alternative medications include other types of muscle relaxants, benzodiazepines, and certain seizure medications like gabapentin. It’s important to know that some alternatives have abuse potential, including benzodiazepines. These options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Other alternatives to baclofen

For people seeking other medications to treat spasticity associated with multiple sclerosis or spinal cord lesions, there are several options. Injections such as botulinum (for example, Botox) are given by a healthcare professional. Other medications are used off-label and have varying evidence for the treatment of muscle spasticity.

Botulinum injections

• Botox (OnabotulinumtoxinA)
• Dysport (AbobotulinumtoxinA)
• Myobloc (RimabotulinumtoxinB)

Medical cannabinoids

• Marinol, Ѕуnԁrοs (dronabinol)

Other medications used off-label

• Clonidine
• Keppra (levetiracetam)
• Lyrica (pregabalin)
• Tegretol (carbamazepine)

Top 5 baclofen alternatives

The following are some of the most common alternatives to baclofen.

1. Zanaflex (tizanidine)

Zanaflex is a brand-name medication that is available as a generic drug called tizanidine. This medication is used to manage spasticity in people with conditions such as spinal cord injury, cerebral palsy, or multiple sclerosis, as these conditions can have varying degrees of spasticity. Tizanidine is also commonly used off-label for musculoskeletal pain. Tizanidine has been found to reduce stiff muscles, and clinical trials have shown about the same efficacy as baclofen for spasticity treatment. A possible advantage of tizanidine is that the muscle weakness that comes with most oral antispastic drugs is less of a problem with tizanidine. It’s important to avoid tizanidine if also taking the medications fluvoxamine or ciprofloxacin due to dangerous drug interactions. Tizanidine is available as oral tablets and capsules and is typically taken every six to eight hours as needed.

RELATED: Tizanidine interactions to avoid

2. Dantrium (dantrolene)

Dantrium is a brand-name medication available as a generic medicine called dantrolene. Dantrolene is used to treat spasticity associated with conditions such as spinal cord injury, stroke, cerebral palsy, or multiple sclerosis. For the treatment of spasticity, dantrolene reduces involuntary muscle contractions and relaxations and overactive or over-responsive bodily reflexes. This medication does have a boxed warning for liver toxicity and should not be used in people with liver disease. Additionally, dantrolene doesn’t selectively target specific muscles and may cause general muscle weakness. Dantrolene is available as oral capsules and is usually taken three to four times a day.

3. Valium (diazepam)

Valium is the brand name of a benzodiazepine medication also available as a generic called diazepam. Commonly used for anxiety disorders and seizure disorders, diazepam can help slow down the central nervous system (CNS). This effect causes sedation, a potential benefit in reducing spasticity at night, leading to fewer sleep interruptions. Evidence has found that diazepam improves hyperactive reflexes and painful spasms. Benzodiazepines like diazepam have abuse potential and the potential for serious sedation when combined with opioids. Diazepam oral dosage formulations include tablets and solutions typically taken three to four times a day.

RELATED: How much is diazepam (Valium) without insurance?

4. Klonopin (clonazepam)

Klonopin is another brand name for a benzodiazepine medication that can be used to treat spasticity. Available as a generic called clonazepam, this alternative also has anti-anxiety, anti-seizure, sedation, and muscle-relaxant effects. Like other alternatives, it’s important to carefully monitor the effect of treatment since too much medicine can cause extreme fatigue and weakness, while too little doesn’t help the spasticity. Clonazepam has the same abuse potential as other benzodiazepines and should be used with caution in the elderly and with alcohol. Sometimes, benzodiazepines are only used short-term due to tolerance and dependence. Clonazepam is available as oral and disintegrating tablets (ODTs) and is typically taken two to three times a day.

5. Neurontin (gabapentin)

Neurontin is a commonly used prescription medication available as a generic called gabapentin. Although gabapentin is an anti-seizure medication, it can be used for a variety of conditions, including generalized anxiety disorder, neuropathic pain, fibromyalgia, and spasticity. This alternative is often used when people have symptoms consistent with neuropathic pain along with spasticity. Gabapentin can be used in addition to other spasticity treatments. Common side effects include sedation and weakness. Gabapentin is available in several oral dosage formulations, including capsules, solutions, and tablets.

RELATED: Gabapentin side effects and how to avoid them

Natural alternatives to baclofen

Alternative remedies to help improve spasticity due to multiple sclerosis or spinal cord injuries are commonly used and recommended. These treatments include exercise and stretching, physical therapy, complementary and alternative medicine (CAM) therapies (for example, relaxation techniques and deep breathing exercises), aquatic therapy, braces, and other devices. These remedies can help people be more comfortable, stronger, and move more freely.

Aquatic therapy is a type of exercise in a swimming pool supported by the Multiple Sclerosis Association of America. Due to the water’s natural buoyancy, people suffering from spasticity can move around with less effort. Exercises such as stretching and range-of-motion may be performed in a pool.

How to switch to a baclofen alternative

1. Discuss all health conditions with a healthcare provider

Before switching from baclofen to an alternative, the prescribing healthcare provider must review all health conditions. Some alternatives should be avoided in people with liver disease or in older adults, and alternative benzodiazepines should be avoided in people with a history of medication abuse. It’s important to seek medical advice before changing medication therapy.

2. Do not suddenly stop taking baclofen

Sudden discontinuation of baclofen can lead to withdrawal symptoms. A slow, gradual discontinuation is advised when stopping baclofen treatment to avoid serious central nervous system (CNS) depression. Withdrawal symptoms can include agitation, insomnia, confusion, delusions, hallucinations, seizures, visual changes, psychosis, and increased spasticity.

3. Discuss all medications with a healthcare provider

Before switching from baclofen to an alternative, it’s important that a healthcare provider has reviewed a medication list, including prescription drugs, over-the-counter (OTC) medications, and supplements. Alternatives may have drug interactions that should be avoided.