Lioresal Intrathecal (Baclofen)

• Lioresal Intrathecal, a baclofen‑based therapy, is indicated for conditions involving central nervous system‑mediated muscle spasticity.
• Multiple sclerosis spasticity: reduces hypertonic muscle activity, helping patients achieve better limb control and reduce pain.
• Spinal cord injury spasticity: diminishes involuntary muscle contractions, supporting improved mobility and ease of caregiving.
• Severe refractory spasticity: offers targeted intrathecal delivery when oral antispasmodics fail, allowing lower systemic exposure.
• Other central spasticity conditions: may be considered for off‑label use under specialist supervision.

• Baclofen acts as an agonist at GABA_B receptors located on presynaptic terminals in the dorsal horn of the spinal cord. Activation of these metabotropic receptors inhibits calcium influx, reducing release of excitatory neurotransmitters such as glutamate and substance P. This dampens neuronal firing and decreases the reflex arcs that generate muscle hypertonia, thereby alleviating spasticity through sustained receptor engagement and modulation of interneuronal circuits.

Baclofen administered intrathecally may be associated with a range of adverse reactions, varying in frequency and severity.

Common Side Effects

• Headache: mild to moderate pain often transient.
• Nausea: feeling of sickness, may resolve spontaneously.
• Dizziness: light‑headed sensation, especially after dose changes.
• Fatigue: generalized tiredness.
• Injection site discomfort: pain or irritation at catheter site.
• Hypotension: low blood pressure episodes.

Serious or Rare Side Effects

• Respiratory depression: reduced breathing effort requiring monitoring.
• Seizures: convulsive activity, particularly with abrupt withdrawal.
• Severe hypotension: marked drop in blood pressure with syncope risk.
• Cardiac arrhythmias: irregular heart rhythms.
• Infection: meningitis or catheter‑related infections.
• Withdrawal syndrome: high‑grade spasticity, fever, hallucinations on abrupt cessation.

When using Lioresal Intrathecal, clinicians should observe specific precautions to ensure patient safety and product integrity.

• Patient assessment: evaluate spasticity severity and prior response to oral baclofen before initiating therapy.
• Dose titration: adjust intrathecal dose gradually under specialist supervision to minimize adverse effects.
• Monitoring: conduct regular neurological and cardiovascular assessments during treatment.
• Contraindications: avoid use in patients with known hypersensitivity to baclofen or intrathecal catheter infection.
• Withdrawal risk: do not discontinue abruptly; taper dose to prevent severe rebound spasticity.
• Store at ambient temperature: keep the solution below 25 °C in the original container, protected from light and moisture.

Baclofen may interact with other medications, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Opioids: combined use can enhance central nervous system depression, increasing risk of respiratory compromise.
• Benzodiazepines: additive sedative effects may lead to profound drowsiness or hypotension.

Moderate Interactions (Monitor Closely)

• Antihypertensives: baclofen may potentiate blood pressure‑lowering effects.
• Anticonvulsants: may require dose adjustments due to altered seizure threshold.
• CNS depressants: alcohol or barbiturates can increase sedation.
• Renal impairment drugs: dosage may need modification if co‑administered with nephrotoxic agents.