! Centrally Acting Muscle Relaxants ( Peripherally Acting Muscle Relaxants
" Medications: Baclofen and Cyclobenzaprine (Direct-Acting Skeletal Muscle Relaxants)
# Therapeutic use " Prototype: Dantrolene
Treat painful muscle spasms from: # Therapeutic use
• Spinal cord injury Purpose Condition
• Multiple sclerosis (MS)
↓ Skeletal muscle spasticity Stroke, SCI, MS, CP
• Cerebral palsy
Prevention (oral), Treatment (IV bolus) Malignant Hyperthermia
• Musculoskeletal injuries
⚙ Pharmacologic Action
$ Pharmacologic Action
• Acts directly on skeletal muscle
• Enhances GABA activity at spinal cord level à Suppresses
• Inhibits calcium release → prevents muscle contraction
hyperactive reflexes à ↓ muscle spasticity • Result: Muscle relaxation & spasticity relief
⚠ Adverse EBects
⚠Common Side EBects
CNS eBect: drowsiness, dizziness, weakness, and fatigue
N/V, constipation, urinary retention CNS eWect: Muscle weakness, drowsiness, dizziness, fatigue
Withdrawal (anxiety, restlessness, seizure, hallucination, tremors…) Diarrhea
Liver toxicity (occur with higher dose/long-term use)
& Safety Alerts
• Oral Withdrawal à Taper dose over 1–2 weeks & Safety Alerts
• Intrathecal Baclofen Withdrawal • ↓ Calcium = ↓ strength & ambulation risk
o Risk for rebound spasticity, fever, rhabdomyolysis • Watch for signs of liver failure:
o Can cause organ failure → death o Abdominal pain
' Administration Tips o Jaundice (yellow skin/eyes)
Form Guidelines • Report immediately!
' Administration
Start low, increase by 5 mg every 3 days up
Oral Baclofen Form Use
to 20 mg 3–4x/day
Take with food/milk To reduce GI upset Oral For long-term spasticity
Intrathecal Baclofen if Delivered via programmable pump into IV bolus Emergency treatment of malignant hyperthermia
oral dose ineBective spinal cord
" Medications: Baclofen and Cyclobenzaprine (Direct-Acting Skeletal Muscle Relaxants)
# Therapeutic use " Prototype: Dantrolene
Treat painful muscle spasms from: # Therapeutic use
• Spinal cord injury Purpose Condition
• Multiple sclerosis (MS)
↓ Skeletal muscle spasticity Stroke, SCI, MS, CP
• Cerebral palsy
Prevention (oral), Treatment (IV bolus) Malignant Hyperthermia
• Musculoskeletal injuries
⚙ Pharmacologic Action
$ Pharmacologic Action
• Acts directly on skeletal muscle
• Enhances GABA activity at spinal cord level à Suppresses
• Inhibits calcium release → prevents muscle contraction
hyperactive reflexes à ↓ muscle spasticity • Result: Muscle relaxation & spasticity relief
⚠ Adverse EBects
⚠Common Side EBects
CNS eBect: drowsiness, dizziness, weakness, and fatigue
N/V, constipation, urinary retention CNS eWect: Muscle weakness, drowsiness, dizziness, fatigue
Withdrawal (anxiety, restlessness, seizure, hallucination, tremors…) Diarrhea
Liver toxicity (occur with higher dose/long-term use)
& Safety Alerts
• Oral Withdrawal à Taper dose over 1–2 weeks & Safety Alerts
• Intrathecal Baclofen Withdrawal • ↓ Calcium = ↓ strength & ambulation risk
o Risk for rebound spasticity, fever, rhabdomyolysis • Watch for signs of liver failure:
o Can cause organ failure → death o Abdominal pain
' Administration Tips o Jaundice (yellow skin/eyes)
Form Guidelines • Report immediately!
' Administration
Start low, increase by 5 mg every 3 days up
Oral Baclofen Form Use
to 20 mg 3–4x/day
Take with food/milk To reduce GI upset Oral For long-term spasticity
Intrathecal Baclofen if Delivered via programmable pump into IV bolus Emergency treatment of malignant hyperthermia
oral dose ineBective spinal cord
