Baclofen vs Tizanidine
BaclofenTizanidine
Skeletal Muscle RelaxantDrug ClassSkeletal Muscle Relaxant
Spasticity due to multiple sclerosis, spinal cord injuries, or cerebral palsy.IndicationsSpasticity associated with multiple sclerosis or spinal cord injuries.
Acts on GABA-B receptors in the spinal cord to inhibit reflexes and reduce muscle spasticity.Mechanism of ActionActs as an alpha-2 adrenergic agonist in the CNS to reduce spasticity.
Oral (tablet, liquid); intrathecal (pump)Administration RouteOral (tablet, capsule)
Starting: 5 mg orally 3x/day; max: 80 mg/dayDosageStarting: 2 mg every 6–8 hours; max: 36 mg/day
Drowsiness, dizziness, nausea, weakness, headache, fatigue.Common Side EffectsDry mouth, drowsiness, dizziness, weakness, low blood pressure.
Seizures (if stopped abruptly), confusion, hallucinations, low blood pressure.Severe Side EffectsLiver damage, hallucinations, low blood pressure, bradycardia.
Increases sedation with CNS depressants (alcohol, benzodiazepines).Drug InteractionsAdditive effects with CNS depressants; CYP1A2 inhibitors (e.g., fluvoxamine) increase levels.
2–4 hours (oral); 5–6 hours (intrathecal)Half-Life2.5 hours
Limited hepatic metabolism; excreted mainly by kidneys.MetabolismExtensively metabolized in the liver (CYP1A2 enzyme).
Urine (majority unchanged)ExcretionUrine (metabolites)
Category C (Risk cannot be ruled out)Pregnancy CategoryCategory C (Risk cannot be ruled out)
Gradual tapering required to avoid withdrawal symptoms (e.g., seizures).Tapering RequirementGradual tapering required to avoid rebound spasticity or withdrawal.
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