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Thread: need advice on changing spasticity meds

  1. #1

    need advice on changing spasticity meds

    I have always taken 60mg of baclofen and .1mg of clonidine which has worked well for me. however I have been struggling with morning hypotension and I'm thinking it would probably help to get off clonidine since it's a blood pressure med. I see the max dose of baclofen is 80mg so it seemed logical to consider dropping the clon for more baclofen, no?
    Embrace uncertainty. Hard problems rarely have easy solutions. Jonah Lehrer

  2. #2
    Is the hypotension only in the mornings? You could see if you could just add one dose of midodrine.
    How dizzy are you getting and for how long etc?
    Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

  3. #3
    mostly it happens in the mornings, occasionally after I eat lunch [ that might be when the bacteria in my bladder gets worse]. If I take more than a half hour to get out of bed I don't usually experience it but when I get out of bed sooner to take a shower I get dizzy unless I both wear a binder and take a cool shower. Isn't that silly? I would rather not add another med if I can but if it keeps worsening...

    eta since wearing the binder I don't get so bad that i faint anymore but I do need to elevate my legs to stop the dizziness.
    Embrace uncertainty. Hard problems rarely have easy solutions. Jonah Lehrer

  4. #4
    Senior Member
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    I was on 120mg of baclofen back in the day and got tired of being a zombie.
    As spasm meds go u name it and i've been on it.
    Now i take 36mg of zanaflex capsules which work like a charm and i only have to take it 3 x a day since they come in 6mg capsules.
    I was on 32mg of the tablets for years but they stopped working.
    The capsules are rather new and there is no generic, however even with my crappy medicare-medi-cal I get them covered and only pay $3.20/month rather than $1550!
    Anyway it took me a while to get used to the drowsiness and dizziness but now I'm at school most of the day and tolerate the zanaflex with nearly no side effects.
    I also took midodrine for a while for low BP.
    My normal bp hovers around 90/50 on a good day since I'm a c7-t1.
    good luck
    kel

  5. #5
    I would discuss with you doctor. but 60 mg is not the max dose. maybe you could increase Balofen and cut down some on Cl.

    CWO

  6. #6
    Senior Member
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    Les,

    Are you sure the clonidine helps in your case? If not, the choice is easy, there are better alternatives out there even more so considering your hypotension problems. Did you end up using it because of really refractory spasticity despite increasing baclofen or using other drugs?
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

  7. #7
    I've used both oral baclofen and zanaflex (tizanidine). In my case, the zanaflex is far more effective at stopping spasms, but at the price of whacking me out a lot more -- severe dizziness, sleepiness (this goes way beyond drowsiness), and feeling totally stoned for about two hours after taking it -- and it causes far worse constipation. I've been on it for four months now for upper body spasms that my pump can't help, and there's no sign that these side effects are getting any less significant.

    Since you're already "adjusted" to baclofen, it does seem that a bump to 80 mg would be the way to go instead of changing meds completely. If you were taking a higher dose of baclofen, I'd suggest you look into the pump -- way more effective for me than any oral med, and zero side effects.

    JGNI, what better alternatives are out there? (Just curious.)
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  8. #8
    Senior Member
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    Hi thehipcrip,

    You already just mentioned 3 of them:

    - increase oral dose of baclofen
    - tizanidine (less muscle weakness than baclofen, combination with baclofen at lower dosage is a good way to get benefits of both and minimizing side effects)
    - baclofen pump (although much more invasive)
    - cannabis or cannabis based medecine

    My point was about hypotension, which is enough of a problem in quadriplegia without adding an anti-hypertensive drug to it with the following increase in hypotension. Moreover, clonidine has only been shown effective in open label studies, not in randomized control trials.

    Other less interesting drugs, in my opinion, would be dantrolene, gabapentine, lamotrigine and cyproheptadine.
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

  9. #9
    Quote Originally Posted by JGNI View Post
    Les,

    Are you sure the clonidine helps in your case? If not, the choice is easy, there are better alternatives out there even more so considering your hypotension problems. Did you end up using it because of really refractory spasticity despite increasing baclofen or using other drugs?
    I'm pretty sure it works as ages ago I forgot to take it one night and I remember my spasms getting crazy. I was 15 when I started taking it in rehab, I have no memory of why Maybe I should try cutting the tiny pill in half take that and see what happens, tho I did some reading on the web and there were all kinds of warnings on weaning off it. Is the .1mg the smallest dose?

    kel how long did it take to adjust to the drowsiness?

    cwo I'm without a physiatrist, the local ones haven't been too helpful but I'll try again.
    Last edited by leschinsky; 04-29-2010 at 09:38 PM. Reason: typos
    Embrace uncertainty. Hard problems rarely have easy solutions. Jonah Lehrer

  10. #10
    Cutting is okay. Increase the Baclofenby half a pill( 15 mg) also you might want to start at night.

    CWO

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