Section 09
Spasticity
Tone & Muscle Spasm Management
12 AGENTS
Baclofen
LioresalGABA-B agonist
- Forms
- Tab: 10, 20mg | Intrathecal: 0.05, 0.5, 2mg/mL
- Dose
- Start 5mg TID, titrate to 40-80mg/day
- MOA
- Presynaptic GABA-B agonism, ↓spasticity
Tizanidine
ZanaflexAlpha-2 agonist
- Forms
- Tab: 2, 4mg | Cap: 2, 4, 6mg
- Dose
- Start 2mg qHS, titrate to 8mg TID (max 36mg/day)
- MOA
- Central α2-adrenergic agonism
Dantrolene
DantriumRyanodine receptor antagonist
- Forms
- Cap: 25, 50, 100mg
- Dose
- Start 25mg/day, titrate to 100mg TID-QID
- MOA
- Blocks Ca2+ release from sarcoplasmic reticulum
Diazepam
ValiumBenzodiazepine
- Forms
- Tab: 2, 5, 10mg
- Dose
- 2-10mg TID-QID
- MOA
- ↑GABA-A Cl- channel frequency
Cyclobenzaprine
FlexerilMuscle relaxant (TCA-like)
- Forms
- Tab: 5, 7.5, 10mg | ER cap: 15, 30mg
- Dose
- 5-10mg TID (short-term)
- MOA
- Central alpha-2 & 5-HT2 modulation
Carisoprodol
SomaMuscle relaxant
- Forms
- Tab: 250, 350mg
- Dose
- 250-350mg TID + qHS (short-term)
- MOA
- CNS depressant, GABA-A modulation
Methocarbamol
RobaxinMuscle relaxant
- Forms
- Tab: 500, 750mg | IV/IM: 100mg/mL
- Dose
- 1000-1500mg QID
- MOA
- CNS depressant (mechanism unclear)
Metaxalone
SkelaxinMuscle relaxant
- Forms
- Tab: 400, 800mg
- Dose
- 800mg TID-QID
- MOA
- CNS depressant (mechanism unclear)
OnabotulinumtoxinA
BotoxNeurotoxin · injectable
- Forms
- IM, unit-dosed per muscle group
- Dose
- per muscle group, q12 weeks
- MOA
- Blocks presynaptic ACh release at NMJ
AbobotulinumtoxinA
DysportNeurotoxin · injectable
- Forms
- IM, unit-dosed per muscle group
- Dose
- per muscle group, q12 weeks
- MOA
- Blocks presynaptic ACh release at NMJ
IncobotulinumtoxinA
XeominNeurotoxin · injectable
- Forms
- IM, unit-dosed per muscle group
- Dose
- per muscle group, q12 weeks
- MOA
- Blocks presynaptic ACh release at NMJ
RimabotulinumtoxinB
MyoblocNeurotoxin · injectable
- Forms
- IM, unit-dosed per muscle group
- Dose
- per muscle group, q12-16 weeks
- MOA
- Blocks presynaptic ACh release at NMJ