Skeletal muscle relaxants and spasticity
NICE Guidance (see also drug-specific links below)
See management of multiple sclerosis in adults.
Baclofen and dantrolene are used for the relief of chronic muscle spasm or spasticity associated with multiple sclerosis or other neurological damage. They are not indicated for spasm associated with minor injuries.
Dantrolene acts directly on skeletal muscle and produces fewer central adverse effects. Dose should be increased slowly. It is also used in Malignant Hyperthermia.
Baclofen inhibits transmission at spinal level and may also depress the central nervous system. Dose should be increased slowly to avoid major side effects of sedation and muscular hypotonia. Withdrawal of treatment should also be gradual.
Diazepam may be used but sedation is a disadvantage. Muscle relaxant doses are similar to anxiolytic doses.
Sativex oromucosal spray - please refer to the shared care prescribing guidelines for its use in treatment of spasticity in patients with multiple sclerosis.