Baclofen vs. lorazepam
- Baclofen and lorazepam are both used as muscle relaxants.
- Lorazepam belongs to the benzodiazepine class of drugs that is typically used to treat anxiety.
- Brand names for baclofen include Gablofen and Lioresal. The brand name for lorazepam is Ativan.
- Side effects of baclofen and lorazepam that are similar include drowsiness, dizziness, weakness, headache, and trouble sleeping (insomnia).
- Side effects of baclofen that are different from lorazepam include seizures, nausea, vomiting, low blood pressure, constipation, confusion, respiratory depression, and increased urinary frequency or urinary retention.
- Side effects of lorazepam that are different from baclofen include unsteadiness, depression, amnesia, and loss of orientation.
- Suddenly stopping oral baclofen may cause seizures and hallucinations. Suddenly stopping lorazepam after prolonged use can lead to symptoms of withdrawal such as insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, and fatigue.
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?
Common side effects of baclofen are:
- low blood pressure,
- respiratory depression,
- inability to sleep,
- and increased urinary frequency or urinary retention.
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.
The most common side effects associated with Ativan are:
Other side effects include:
Possible serious side effects include:
- Extrapyramidal symptoms
- Respiratory depression
- Suicidal ideation/attempt
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?
- 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.
- 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?
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.
Because baclofen can increase blood sugar, doses of antidiabetic drugs may need to be adjusted when baclofen is begun.
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?
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.
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.