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Dantrolene, although thought of primarily as a peripherally acting agent, is associated with CNS effects, whereas baclofen activity is strictly associated with the CNS. Muscle relaxants are thought to be useful in painful disorders based on the theory that pain induces spasm and spasm causes pain.
Dantrolene sodium, sold under the brand name Dantrium among others, is a postsynaptic muscle relaxant that lessens excitation-contraction coupling in muscle cells. [ 5 ] [ 6 ] [ 7 ] It achieves this by inhibiting Ca 2+ ions release from sarcoplasmic reticulum stores by antagonizing ryanodine receptors . [ 8 ]
Baclofen, diazepam and dantrolene remain the three most commonly used pharmacologic agents in the treatment of spastic hypertonia. Baclofen is generally the drug of choice for spinal cord types of spasticity, while sodium dantrolene is the only agent which acts directly on muscle tissue. Tizanidine is also available.
There is evidence, albeit limited, of the clinical effectiveness of baclofen, [168] dantrolene, [169] diazepam, [170] and tizanidine. [171] [172] [173] In the most complicated cases intrathecal injections of baclofen can be used. [174] There are also palliative measures like castings, splints or customized seatings. [93]
Effectiveness has not been clearly shown for metaxalone, methocarbamol, chlorzoxazone, baclofen, or dantrolene. [7] Applicable conditions include acute back [8] or neck pain, or pain after an injury. Long-term use of muscle relaxants in such cases is poorly supported. [8]
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Baclofen, sold under the brand name Lioresal among others, is a medication used to treat muscle spasticity, such as from a spinal cord injury or multiple sclerosis. [ 8 ] [ 9 ] It may also be used for hiccups and muscle spasms near the end of life, [ 9 ] and off-label to treat alcohol use disorder [ 10 ] [ 11 ] or opioid withdrawal symptoms. [ 12 ]