Baclofen vs. Lorazepam

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Baclofen vs. lorazepam

What is baclofen and lorazepam?

Baclofen is a medication that relaxes skeletal muscles. Chemically, baclofen is related to gamma-aminobutyric acid (GABA), a naturally occurring neurotransmitter in the brain. Neurotransmitters are chemicals that nerves use to communicate with one another. GABA released by some nerves causes the activity of other nerves to decrease. It is believed that baclofen, acting like GABA, blocks the activity of nerves within the part of the brain that controls the contraction and relaxation of skeletal muscle.

Lorazepam is used for the management of anxiety disorders, the short-term relief of symptoms of anxiety or anxiety associated with depression. Lorazepam is also effective for insomnia and panic attacks, and is used in combination with other medications to prevent nausea and vomiting resulting from chemotherapy. Lorazepam also is administered before anesthesia for sedation and used for prevention and treatment of alcohol withdrawal. It also is used for treating seizures (status epilepticus). Lorazepam belongs to the benzodiazepine family of drugs that includes diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), flurazepam (Dalmane), and others.

What are the side effects of baclofen and lorazepam?

Baclofen

Common side effects of baclofen are:

Abrupt discontinuation of oral baclofen may cause seizures and hallucinations. Abrupt discontinuation of intrathecal baclofen may result in:

  • high fever,
  • rebound spasticity,
  • muscle rigidity, and
  • rhabdomyolysis (muscle breakdown) that can progress to failure of several organs, including the kidney, and even death.

Lorazepam

The most common side effects associated with Ativan are:

  • Sedation
  • Dizziness
  • Weakness
  • Unsteadiness

Other side effects include:

  • A feeling of depression
  • Amnesia
  • Loss of orientation
  • Headache
  • Sleep disturbance

Possible serious side effects include:

  • Extrapyramidal symptoms
  • Respiratory depression
  • Suicidal ideation/attempt
  • Seizures
  • Depression

WARNING:

Like all benzodiazepines, Ativan can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If Ativan is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and sweating.

What is the dosage of baclofen vs. lorazepam?

Baclofen

  • The usual starting dose of oral baclofen for treating spasticity in adults is 5 mg given three times daily.
  • Based on the response, the dose can be increased by 5 mg every three days to a maximum of 80 mg/day in divided doses.

Lorazepam

  • The dose of Ativan is tailored to the patient's needs.
  • The usual dose for treating anxiety is 2-6 mg orally every 8 to 12 hours as needed.
  • Insomnia is treated with 2-4 mg given at bedtime.

What drugs interact with baclofen and lorazepam?

Baclofen

Use of baclofen with other drugs that also depress the function of nerves may lead to additional reduction in brain function.

In addition to the risk of depressing brain function, the use of baclofen and tricyclic antidepressants (for example, amitriptyline [Elavil, Endep], doxepin [Sinequan, Adapin]) together may cause muscle weakness.

Use of baclofen and monoamine oxidase inhibitors (for example, phenelzine [Nardil], tranylcypromine or [Parnate]) can result in greater depression of brain function as well as low blood pressure.

Because baclofen can increase blood sugar, doses of antidiabetic drugs may need to be adjusted when baclofen is begun.

Lorazepam

Ativan and all benzodiazepines accentuate the effects of other drugs that slow the brain's processes such as alcohol, barbiturates, narcotics, and tranquilizers, and the combination of Ativan and these drugs may lead to excessive sedation. There have been cases of marked sedation when Ativan was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction, but caution should be used if Ativan and loxapine are used together.

Are baclofen or lorazepam safe to take while pregnant or breastfeeding?

Baclofen

The use of baclofen by pregnant women has not been evaluated.

Baclofen can be detected in the breast milk of mothers taking oral baclofen. No information is available on the presence of baclofen in the breast milk of mothers receiving baclofen intrathecally.

Lorazepam

Ativan and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Ativan is best avoided if at all possible in the first trimester and probably throughout pregnancy.

Ativan is excreted in human milk and should be avoided during pregnancy.

Summary

Baclofen (Gablofen, Lioresal) and lorazepam (Ativan) are both used as muscle relaxers, though lorazepam is primarily an anti-anxiety medication in the benzodiazepine family. Both drugs are habit-forming and can cause withdrawal symptoms if stopped suddenly. Learn more about baclofen and lorazepam side effects, dosage, and pregnancy safety information.

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Medically Reviewed on 10/27/2017
References
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