A GABA-B receptor agonist used for the treatment of spasticity resulting from multiple sclerosis, spinal cord injuries, and other spinal cord diseases. Baclofen is also available as an intrathecal formulation for severe spasticity not adequately managed by oral therapy. It is sometimes used off-label for alcohol use disorder.
Do not abruptly withdraw (risk of life-threatening withdrawal syndrome)4
The bottom line
Evidence rating strong. Most-documented uses: reduction of spasticity from spinal cord lesions, treatment of ms-related spasticity, relief of muscle spasms and clonus. 10 sources indexed (2019–2024), with 1 interaction record on file.
The science
How it works, mechanistically.
Core mechanism
Acts as an agonist at GABA-B receptors in the spinal cord and brain. By activating presynaptic GABA-B receptors, baclofen inhibits the release of excitatory neurotransmitters (glutamate, aspartate) at spinal motor neuron synapses, reducing monosynaptic and polysynaptic reflexes. This decreases muscle tone and the frequency of muscle spasms without directly affecting neuromuscular transmission.6
Class
Skeletal Muscle Relaxant (Antispastic)
Absorption
Water-soluble; take with food
Dosing
Dosing & protocol.
Common range
Oral: start 5 mg three times daily, titrate to 40–80 mg/day in divided doses (max 80 mg/day); Intrathecal: individualized (as prescribed by your physician)
Recommended form
Tablet or intrathecal injection (via pump)
Take with food to reduce GI side effects; do not abruptly discontinue, taper gradually to avoid withdrawal symptoms8
Safety
Full safety detail.
Side effects
Drowsiness and sedation
Dizziness
Weakness
Nausea
Headache
Confusion (especially in elderly)
Withdrawal syndrome if abruptly discontinued (hallucinations, seizures, rebound spasticity)
Alcohol and baclofen can both cause sedation, dizziness, slowed reaction time, and impaired coordination. Human alcohol-challenge studies show baclofen can increase sedation and impair performance, and higher baclofen plus alcohol exposure has been associated with major sedation. This is especially risky for driving, falls, and accidental overdose.
Recommendation: Avoid alcohol while taking baclofen unless your prescriber is deliberately supervising baclofen for alcohol use disorder. Do not drive or operate machinery if you have used both. Report heavy sedation, confusion, fainting, or breathing problems promptly.
Viana Pinto L, Romeiro I, Gouveia F et al.. Intrathecal baclofen for the management of hereditary spastic paraparesis: a systematic review. International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation. 2024
Duan F, Zhai H, Liu C et al.. Systematic review and meta-analysis: Efficacy and safety of baclofen in patients with alcohol use disorder co-morbid liver diseases. Journal of psychiatric research. 2023
Lee HP, Win T, Balakrishnan S. The impact of intrathecal baclofen on the ability to walk: A systematic review. Clinical rehabilitation. 2023
4Psychosis Related to Baclofen Withdrawal or Overdose: A Systematic ReviewNeeds reviewPMIDPhu PJJ, Looi JCL, Nair PC et al. · East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan · 2023
Phu PJJ, Looi JCL, Nair PC et al.. Psychosis Related to Baclofen Withdrawal or Overdose: A Systematic Review. East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan. 2023
Buizer AI, Martens BHM, Grandbois van Ravenhorst C et al.. Effect of continuous intrathecal baclofen therapy in children: a systematic review. Developmental medicine and child neurology. 2019
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