▶Uncommon
▶With intrathecal useAlopecia.deep vein thrombosis.
dehydration.flushing.hypertension.ileus.memory loss.
pallor.paranoia.suicidal tendencies
▶Rare or very rare
▶With oral useAbdominal pain.hepatic function abnormal
▶Frequency not known
▶With intrathecal useScoliosis
lPREGNANCYManufacturer advises use only if potential
benefit outweighs risk (toxicity inanimalstudies).
lBREAST FEEDINGPresent in milk—amount probably too
small to be harmful.
lHEPATIC IMPAIRMENT
▶With oral useManufacturer advises use with caution.
lRENAL IMPAIRMENTExcreted by the kidney.
Dose adjustments▶With oral useRisk of toxicity—use
smaller oral doses and if necessary increase dosage
interval; if estimated glomerularfiltration rate less than
15 mL/minute/ 1. 73 m2
use by mouth only if potential
benefit outweighs risk.
lTREATMENT CESSATIONAvoid abrupt withdrawal (risk of
hyperactive state, may exacerbate spasticity, and
precipitate autonomic dysfunction including
hyperthermia, psychiatric reactions and convulsions; to
minimise risk, discontinue by gradual dose reduction over
at least 1 – 2 weeks (longer if symptoms occur)).
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral liquid formulations may include raspberry.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Baclofen for muscle spasm
http://www.medicinesforchildren.org.uk/baclofen-muscle-spasm
Driving and skilled tasksDrowsiness may affect
performance of skilled tasks (e.g. driving); effects of
alcohol enhanced.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution, solution
for injection
Tablet
CAUTIONARY AND ADVISORY LABELS2, 8, 21
EXCIPIENTS:May contain Gluten
▶Baclofen (Non-proprietary)
Baclofen 10 mgBaclofen 10 mg tablets| 84 tabletP£ 9. 99 DT =
£ 1. 07
▶Lioresal(Novartis Pharmaceuticals UK Ltd)
Baclofen 10 mgLioresal 10 mg tablets| 100 tabletP£ 14. 86
Solution for injection
▶Baclofen (Non-proprietary)
Baclofen 50 microgram per 1 mlBaclofen 50 micrograms/ 1 ml
solution for injection ampoules| 10 ampouleP£ 25. 00 – £ 27. 60
▶Lioresal(Novartis Pharmaceuticals UK Ltd)
Baclofen 50 microgram per 1 mlLioresal Intrathecal
50 micrograms/ 1 ml solution for injection ampoules| 1 ampouleP
£ 3. 16
Solution for infusion
▶Baclofen (Non-proprietary)
Baclofen 500 microgram per 1 mlBaclofen 10 mg/ 20 ml solution for
infusion ampoules| 1 ampouleP£ 50. 00 – £ 57. 00
Baclofen 2 mg per 1 mlBaclofen 40 mg/ 20 ml solution for infusion
ampoules| 1 ampouleP£ 228. 00 – £ 250. 00
Baclofen 10 mg/ 5 ml solution for infusion ampoules|
10 ampouleP£ 500. 00 – £ 570. 00
▶Lioresal(Novartis Pharmaceuticals UK Ltd)
Baclofen 500 microgram per 1 mlLioresal Intrathecal 10 mg/ 20 ml
solution for infusion ampoules| 1 ampouleP£ 70. 01
Baclofen 2 mg per 1 mlLioresal Intrathecal 10 mg/ 5 ml solution for
infusion ampoules| 1 ampouleP£ 70. 01
Oral solution
CAUTIONARY AND ADVISORY LABELS2, 8, 21
▶Baclofen (Non-proprietary)
Baclofen 1 mg per 1 mlBaclofen 5 mg/ 5 ml oral solution sugar free
sugar-free| 300 mlP£ 13. 45 DT = £ 2. 71▶Lioresal(Novartis Pharmaceuticals UK Ltd)
Baclofen 1 mg per 1 mlLioresal 5 mg/ 5 ml liquid sugar-free|
300 mlP£ 10. 31 DT = £ 2. 71
▶Lyflex(Chemidex Pharma Ltd)
Baclofen 1 mg per 1 mlLyflex 5 mg/ 5 ml oral solution sugar-free|
300 mlP£ 7. 95 DT = £ 2. 713 Pain and inflammation in
musculoskeletal disorders
Non-steroidal anti-inflammatory
drugs
Therapeutic effects
Insingle dosesnon-steroidal anti-inflammatory drugs
(NSAIDs) have analgesic activity comparable to that of
paracetamol p. 271 but paracetamol is preferred.
In regularfull dosageNSAIDs have both a lasting analgesic
and an anti-inflammatory effect which makes them
particularly useful for the treatment of continuous or regular
pain associated with inflammation.Choice
Differences in anti-inflammatory activity between NSAIDs
are small, but there is considerable variation in individual
response and tolerance of these drugs. A large proportion of
children will respond to any NSAID; of the others, those who
do not respond to one may well respond to another. Pain
relief starts soon after taking thefirst dose and a full
analgesic effect should normally be obtained within a week,
whereas an anti-inflammatory effect may not be achieved (or
may not be clinically assessable) for up to 3 weeks. However,
in juvenile idiopathic arthritis NSAIDs may take 4 – 12 weeks
to be effective. If appropriate responses are not obtained
within these times, another NSAID should be tried. The
availability of appropriate formulations needs to be
considered when prescribing NSAIDs for children.
NSAIDs reduce the production of prostaglandins by
inhibiting the enzyme cyclo-oxygenase. They vary in their
selectivity for inhibiting different types of cyclo-oxygenase;
selective inhibition of cyclo-oxygenase- 2 is associated with
less gastro-intestinal intolerance. However, in children
gastro-intestinal symptoms are rare in those taking NSAIDs
for short periods. The role of selective inhibitors of cyclo-
oxygenase- 2 is undetermined in children.
Ibuprofen p. 655 and naproxen p. 659 are propionic acid
derivatives used in children.
Ibuprofen combines anti-inflammatory, analgesic, and
antipyretic properties. It has fewer side-effects than other
NSAIDs but its anti-inflammatory properties are weaker.
Naproxen combines good efficacy with a low incidence of
side-effects.
Diclofenac sodium p. 652 , diclofenac potassium p. 651 ,
indometacin p. 657 , mefenamic acid p. 658 , and piroxicam
p. 660 have properties similar to those of propionic acid
derivatives:
Diclofenac sodium and diclofenac potassium are similar in
efficacy to naproxen.
Indometacin has an action equal to or superior to that of
naproxen, but with a high incidence of side-effects including
headache, dizziness, and gastro-intestinal disturbances. It is
rarely used in children and should be reserved for when
other NSAIDs have been unsuccessful.
Mefenamic acid has minor anti-inflammatory properties.
It has occasionally been associated with diarrhoea and
haemolytic anaemia which require discontinuation of
treatment.
Piroxicam is as effective as naproxen and has a long
duration of action which permits once-daily administration.650 Pain and inflammation in musculoskeletal disorders BNFC 2018 – 2019
Musculoskeletal system10