What's the difference between gabapentin and baclofen?

What are gabapentin and baclofen?

Gabapentin is an anti-seizure (anticonvulsant) drug that is used for preventing seizures and for treating post-herpetic neuralgia, the pain that follows an episode of shingles. Other off-label uses for gabapentin include anxiety, alcohol withdrawal, cocaine withdrawal, hiccups, restless leg syndrome, hyperhidrosis, headaches, diabetic neuropathy, hot flashes, and fibromyalgia.

Baclofen is a skeletal muscle relaxer. It is believed that baclofen acts like the neurotransmitter gamma-aminobutyric acid (GABA) and blocks the activity of nerves within the part of the brain that controls the contraction and relaxation of skeletal muscle. Baclofen is used for treating skeletal muscle spasms, muscle clonus, rigidity, and pain caused by disorders such as multiple sclerosis. It is also injected into the spinal cord for management of severe spasticity.

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What are the side effects of gabapentin and baclofen?

Gabapentin side effects

The most common side effects of gabapentin are:

Other adverse effects and serious side effects associated with gabapentin include:

Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

Baclofen side effects

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.

What is the dosage of gabapentin vs. baclofen?

Gabapentin dosage

Dosage for Postherpetic Neuralgia

  • In adults with postherpetic neuralgia, gabapentin may be initiated on Day 1 as a single 300 mg dose, on Day 2 as 600 mg/day (300 mg two times a day), and on Day 3 as 900 mg/day (300 mg three times a day).

Dosage for Epilepsy with Partial Onset Seizures

Patients 12 Years Of Age And Above
  • The starting dose is 300 mg three times a day. The recommended maintenance dose of gabapentin is 300 mg to 600 mg three times a day. Dosages up to 2400 mg/day have been well tolerated in long-term clinical studies.
Pediatric Patients Age 3 To 11 Years
  • The starting dose range is 10 mg/kg/day to 15 mg/kg/day, given in three divided doses, and the recommended maintenance dose reached by upward titration over a period of approximately 3 days.

Dosage Adjustment in Patients with Renal Impairment

  • Dosage adjustment in patients 12 years of age and older with renal impairment or undergoing hemodialysis varies depending on the person's creatinine clearance.
  • The use of gabapentin in patients less than 12 years of age with compromised renal function has not been studied.

Dosage in Elderly

  • Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and dose should be adjusted based on creatinine clearance values in these patients.

Administration Information

  • Administer gabapentin orally with or without food.
  • Gabapentin capsules should be swallowed whole with water.
  • Inform patients that, should they divide the scored 600 mg or 800 mg gabapentin tablet in order to administer a half-tablet, they should take the unused half-tablet as the next dose. Half-tablets not used within 28 days of dividing the scored tablet should be discarded.
  • If the gabapentin dose is reduced, discontinued, or substituted with an alternative medication, this should be done gradually over a minimum of 1 week (a longer period may be needed at the discretion of the prescriber).

Baclofen dosage

The determination of optimal dosage requires individual titration. Start therapy at a low dosage and increase gradually until optimum effect is achieved (usually between 40-80 mg daily).

The following dosage titration schedule is suggested:

5 mg t.i.d. for 3 days
10 mg t.i.d. for 3 days
15 mg t.i.d. for 3 days
20 mg t.i.d. for 3 days

Thereafter additional increases may be necessary but the total daily dose should not exceed a maximum of 80 mg daily (20 mg q.i.d.).

The lowest dose compatible with an optimal response is recommended. If benefits are not evident after a reasonable trial period, patients should be slowly withdrawn from the drug.

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What drugs interact with gabapentin and baclofen?

Gabapentin interactions

  • Antacids reduce the concentration of gabapentin in blood. Therefore, gabapentin should be administered 2 hours or more after taking antacids.
  • Morphine significantly increases blood concentrations of gabapentin and may increase central nervous system-related adverse events associated with gabapentin.

Baclofen interactions

  • 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.

Are gabapentin and baclofen safe to take while pregnant or breastfeeding?

Gabapentin warnings

Doctors do not know the safety of gabapentin during pregnancy. Gabapentin is secreted in human breast milk; therefore, if you are pregnant you should only use this medication if the benefits outweigh the unknown risk to the fetus.

Baclofen warnings

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.

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Summary

Gabapentin and baclofen are used off-label to treat nerve pain (neuralgia). Gabapentin is also an anti-seizure medication and treats nerve pain from shingles. Baclofen is a muscle relaxant used to treat pain caused by disorders such as multiple sclerosis. It is also injected into the spinal cord for management of severe spasticity.

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Medically Reviewed on 12/6/2021
References
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