Spasticity (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland
  • Management of spasticity involves attention to posture; pain; bowel and bladder function as well as the use of medication.
  • All antispasticity drugs can cause tiredness and affect performance of skilled tasks, eg driving. Care is needed in patients with weakness and spasticity as they may be relying on the muscle tone to maintain posture.
  • Relaxation of the external bladder sphincter may contribute to urinary incontinence.
  • In some rare situations, under specialist supervision, longer term use of benzodiazepines may be indicated.
  • For specialist advice contact Rehabilitation Medicine.

Gabapentin (Analgesics) can provide a useful antispasticity effect off-label with doses and monitoring as for neuropathic pain. Botulinum toxin type A (Drugs used in Parkinsonism and related disorders) is also used under specialist advice for spasticity, dystonia and facial spasms and focal forms of dystonia.

BACLOFEN - (First line)

Therapy notes

CSM advice: Serious side-effects can occur on abrupt withdrawal of baclofen. Discontinue by gradual dose reduction over at least 1 to 2 weeks (longer if symptoms occur). 

Formulation and dosage details

Formulation:

Tablets 10mg

Dosage:

By mouth: 5mg 3 times daily, preferably with or after food, gradually increased; maximum 100mg daily (discontinue if no benefit within 6 weeks).

Formulation and dosage details

Formulation:

Oral solution 5mg/5mL

Dosage:

By mouth: 5mg 3 times daily, preferably with or after food, gradually increased; maximum 100mg daily (discontinue if no benefit within 6 weeks).

CANNABIS EXTRACT

Therapy notes

  • Prescribers should be aware of the abuse potential with Sativex® and the risk of diversion.
  • Sativex® can be used in the treatment of spasticity and symptoms of neuropathic pain off-label in multiple sclerosis where first-line treatments have failed to control the symptoms.
  • There is limited evidence for its effectiveness and due to non-submission of evidence, it is not recommended by SMC.
  • Use of Sativex® should be closely controlled and only through, and under review of, the neurology specialist. See also www.gov.uk.

Formulation and dosage details

Formulation:

Oromucosal spray (Sativex®)  containing dronabinol 27mg/mL and cannabidiol 25mg/mL (s)

TIZANIDINE

Therapy notes

  • Patients taking tizanidine should have their blood pressure and liver function checked monthly for the first 4 months and if they develop unexplained nausea, anorexia or fatigue.
  • Avoid abrupt withdrawal to minimise risk of rebound hypertension and tachycardia.

Formulation and dosage details

Formulation:

Tablets 2mg, 4mg (s)

Dosage:

Initially 2mg daily as a single dose, increased according to response at intervals of at least 3 to 4 days in steps of 2mg daily (and given in divided doses), usually up to 24mg daily in 3 to 4 divided doses; maximum 36mg daily.

CLONAZEPAM

Therapy notes

Formulation and dosage details

Formulation:

Tablets 500 micrograms, 2mg

Dosage:

Painful nocturnal spasms off-label: initially 500 micrograms at night, maximum dose 2mg.

DIAZEPAM

Therapy notes

  • General: Use diazepam for a maximum of 1 week only; avoid long-term use.
  • In some rare situations, under specialist supervision, longer term use of benzodiazepines may be indicated.

Formulation and dosage details

Formulation:

Tablets 2mg, 5mg

Dosage:

Muscle spasm, by mouth: 2 to 15mg daily in divided doses.

Formulation and dosage details

Formulation:

Oral solution 2mg/5mL, 5mg/5mL

Dosage:

Muscle spasm, by mouth: 2 to 15mg daily in divided doses.

Editorial Information

Document Id: F284