Baclofen (Lioresal, Lyflex)

How is it taken? Tablet or liquid

How does it work? A muscle relaxant that works in the central nervous system. It can reduce the number of spasms and levels of muscle stiffness.

Side effects and precautions: It may cause drowsiness, nausea, dry mouth and dizziness. 

Tizanidine (Zanaflex)

How is it taken? Tablet

How does it work? A muscle relaxant that works in the central nervous system. It can reduce stiffness and spasms and may be particularly useful to treat painful night-time spasms. Because its effects last for only 3-6 hours, it can be best used around specific times when relief from symptoms is most important, for example at bedtime.

Side effects and precautions: It may cause drowsiness, fatigue, dry mouth and dizziness. Rarely, it can cause hallucinations. You should be carefully monitored for any effects on your liver, as it can cause problems for some. 

Gabapentin (Neurontin)

How is it taken? Tablet

How does it work? An anticonvulsant drug that calms overactive messages in the central nervous system that might cause spasms. This drug is not used as commonly as baclofen or tizanidine to treat spasms and stiffness in MS, but it can be a suitable option for some.

Side effects and precautions: It may cause drowsiness, fatigue and dizziness. 

Dantrolene sodium (Dantrium)

How is it taken? Tablet

How does it work? This drug works directly on muscles, reducing their ability to contract.

Side effects and precautions: Side effects are common. They include drowsiness, fatigue, dizziness, nausea, speech difficulty and lack of coordination. You should be carefully monitored for any effects on your liver, as it can cause problems for some. 

Diazepam (Diazemuls)

How is it taken? Tablet

How does it work? A muscle relaxant that works in the central nervous system. It can reduce stiffness and spasms. Because of side effects at higher doses, it may be more useful at night. Diazepam is no longer widely used to treat MS spasms and stiffness, but can help some people if other treatments have not worked.

Side effects and precautions: It may cause drowsiness and weakness. Diazepam is a 'benzodiazepine' a type of drug that can be addictive with long-term use, so should not be taken for too long. Your doctor can advise you on this. 

Baclofen pump (also called 'intrathecal baclofen')

How is it taken? The drug is supplied automatically to the fluid around the spinal cord. A small pump that is surgically implanted near the waistline controls the dose. This system is known as 'intrathecal' injection.

How does it work? For those with more severe spasms or stiffness, who do not gain adequate benefit from tablet medications, this can be helpful. By delivering the drug directly to the area in which it works, it can be more effective. Because of this, doses can be kept lower, keeping side effects to a minimum. Fitting the pump, adjusting the doses and refilling it should always be done by fully trained professionals.

Side effects and precautions: Feeling 'lightheaded', confusion and headaches can all be side effects at first, but these normally resolve over time. Potential risks include infection, movement of the device and the wrong dose being given. Newer models of pump mean that pump failure is now rare. 

Liquid phenol (also called 'intrathecal phenol')

How is it taken? The drug is injected directly into the fluid around the spinal cord ('intrathecally').

How does it work? It can be helpful for some people, to treat very severe spasms that do not respond to physiotherapy and other drug treatments. Phenol destroys the nerves that control sensation and movement, so by injecting it at a certain point around the spinal cord, it can stop spasms in the lower parts of the body. The effects of an injection can last several months and injections can be repeated if necessary.

Side effects and precautions: Phenol can affect any nerve in the lower spinal cord, so it can cause the legs, bladder and bowel to become very weak. It is only used where a person already has limited control of these parts of their body.  

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