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Author: V Bassi, M Kita, DS Feldman, and O Devinsky

Medications used in the treatment of spasticity are listed in the table below. Of these, only baclofen, diazepam, tizanidine, and dantrolene are approved by the U.S. Food and Drug Administration (FDA) for treating spasticity.

Treatment generally is initiated at low doses and increased gradually to avoid adverse effects. The lowest effective dose for an individual patient is considered optimal.

Oral antispasticity agents

Agent Starting dose Maximum recommended dosage Side effects Monitoring Special cautions
Baclofen 5 mg/day, increasing to tid 80 mg/day in divided doses Muscle weakness, sedation, fatigue, dizziness, nausea Periodic liver function tests Abrupt cessation associated with seizures
Diazepam 2 mg bid or 5 mg qhs 40–60 mg/day in divided doses Sedation, cognitive impairment, depression Dependence potential Withdrawal syndrome
Tizanidine 2–4 mg/day 36 mg/day in divided doses Drowsiness, dry mouth, dizziness, reversible dose-related elevated liver trans-
aminases		 Periodic liver function tests Not to be used with anti-
hypertensives or clonidine
Clonidine 0.1 mg/day Usual dose in hypertension is 0.2–0.6 mg/day. Doses up to 2.4 mg/day in divided doses have been studied but are rarely employed Bradycardia, hypotension, dry mouth, drowsiness, constipation, dizziness, depression   Add-on agent; hypotension may result; not to be used with tizanidine
Dantrolene 25 mg/day 400 mg/day in divided doses Hepatotoxicity (potentially irreversible), weakness, sedation, diarrhea Periodic liver function tests Hepatotoxicity
Gabapentin 100 mg tid 3,600 mg/day in divided doses Stomach upset    
4-Aminopyridine 10 mg bid or tid   Light-
headedness		    

Adapted from: Bassi V, Kita M, Feldman DS, and Devinsky O. Spasticity. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;231–247. With permission from Elsevier (www.elsevier.com).
Reviewed and revised May 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.