baclofen

Baclofen is primarily used for the treatment of spastic movement disorders, especially in instances of spinal cord injury, and multiple sclerosis.{{cite web | title = Baclofen | url = https://www.drugs.com/monograph/baclofen.html | work = The American Society of Health-System Pharmacists | access-date = 6 December 2011 | archive-date = 26 April 2019 | archive-url = https://web.archive.org/web/20190426153502/https://www.drugs.com/monograph/baclofen.html | url-status = live }} Use in people with stroke, cerebral palsy, or Parkinson's disease is not recommended. Intrathecal baclofen is used for severe spasticity of spinal cord origin, that is refractive to maximum doses of oral antispasmodic agents, or who experience intolerable side effects.{{cite book | vauthors = Ghanavatian S, Derian A | chapter = Baclofen | date = May 2022 | title = StatPearls [Internet] | location = Treasure Island (FL) | publisher = StatPearls Publishing | pmid = 30252293 | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK526037/ }}{{cite book | vauthors = Siu G | date = 2014 | chapter = Pharmacotherapy | veditors = Maitin IB, Cruz E | title = CURRENT Diagnosis & Treatment: Physical Medicine & Rehabilitation. | publisher = McGraw Hill | url = https://accessmedicine.mhmedical.com/content.aspx?bookid=1180§ionid=70377149 | isbn = 978-0-07-179329-2 | archive-date = 25 December 2022 | access-date = 25 December 2022 | archive-url = https://web.archive.org/web/20221225210133/https://accessmedicine.mhmedical.com/content.aspx?bookid=1180§ionid=70377149 | url-status = live }}

Baclofen may be used off-label as a treatment for alcohol use disorder to reduce the risk of relapse, and to increase the number of days that a person can go without drinking alcohol (abstinence days).

It is sometimes used for the treatment of opioid withdrawal symptoms, and may be superior for this purpose to the more-commonly used clonidine.

Baclofen is also used in the treatment of sleep-related painful erections.{{cite journal |vauthors=Vreugdenhil S, Weidenaar AC, de Jong IJ, van Driel MF |date=December 2017 |title=Sleep-Related Painful Erections-A Case Series of 24 Patients Regarding Diagnostics and Treatment Options |journal=Sexual Medicine |volume=5 |issue=4 |pages=e237–e243 |doi=10.1016/j.esxm.2017.09.001 |pmc=5693397 |pmid=29066083}}

Adverse effects include drowsiness, dizziness, weakness, fatigue, headache, trouble sleeping, nausea and vomiting, poor concentration and recall (resembling dementia), urinary retention, or constipation.

Discontinuation of baclofen can be associated with a withdrawal syndrome which resembles benzodiazepine withdrawal and alcohol withdrawal. Withdrawal symptoms are more likely if baclofen is administered intrathecally or for long periods of time (more than a couple of months) and can occur from low or high doses. The severity of baclofen withdrawal depends on the rate at which it is discontinued. Thus to minimise withdrawal symptoms, the dose should be tapered down slowly when discontinuing baclofen therapy. Abrupt withdrawal is more likely to result in severe withdrawal symptoms. Acute withdrawal symptoms can be eased or completely reversed by re-initiating therapy with baclofen.{{cite journal | vauthors = Leo RJ, Baer D | title = Delirium associated with baclofen withdrawal: a review of common presentations and management strategies | journal = Psychosomatics | volume = 46 | issue = 6 | pages = 503–507 | date = Nov–Dec 2005 | pmid = 16288128 | doi = 10.1176/appi.psy.46.6.503 | doi-access = free }}

Withdrawal symptoms may include auditory hallucinations, visual hallucinations, tactile hallucinations, delusions, confusion, agitation, delirium, disorientation, fluctuation of consciousness, insomnia, dizziness, nausea, inattention, memory impairments, perceptual disturbances, itching, anxiety, depersonalization, hypertonia, hyperthermia (higher than normal temperature without infection), formal thought disorder, psychosis, mania, mood disturbances, restlessness, and behavioral disturbances, tachycardia, seizures, tremors, autonomic dysfunction, hyperpyrexia (fever), extreme muscle rigidity resembling neuroleptic malignant syndrome and rebound spasticity.{{cite journal | vauthors = Grenier B, Mesli A, Cales J, Castel JP, Maurette P | title = [Severe hyperthermia caused by sudden withdrawal of continuous intrathecal administration of baclofen] | journal = Annales Françaises d'Anesthésie et de Réanimation | volume = 15 | issue = 5 | pages = 659–662 | year = 1996 | pmid = 9033759 | doi = 10.1016/0750-7658(96)82130-7 }}

File:Baclosan.JPG"]]

Baclofen, at standard dosing, does not appear to possess addictive properties, and has not been associated with any degree of drug craving.{{cite journal | vauthors = Agabio R, Preti A, Gessa GL | title = Efficacy and tolerability of baclofen in substance use disorders: a systematic review | journal = European Addiction Research | volume = 19 | issue = 6 | pages = 325–345 | year = 2013 | pmid = 23775042 | doi = 10.1159/000347055 | s2cid = 1315087 | doi-access =free }} Euphoria is however listed as a common to very common side-effect of baclofen in the BNF 75.{{Cite web|url=https://www.nice.org.uk/bnf-uk-only|title=BNF is only available in the UK|website=NICE|access-date=16 April 2019|archive-date=9 December 2020|archive-url=https://web.archive.org/web/20201209161059/https://www.nice.org.uk/bnf-uk-only|url-status=live}} There are very few cases of abuse of baclofen for reasons other than attempted suicide. In contrast to baclofen, another GABA_B receptor agonist, γ-hydroxybutyric acid (GHB), has been associated with euphoria, abuse, and addiction.{{cite journal | vauthors = van Nieuwenhuijzen PS, McGregor IS, Hunt GE | title = The distribution of gamma-hydroxybutyrate-induced Fos expression in rat brain: comparison with baclofen | journal = Neuroscience | volume = 158 | issue = 2 | pages = 441–455 | date = January 2009 | pmid = 18996447 | doi = 10.1016/j.neuroscience.2008.10.011 | s2cid = 22701676 }} These effects are likely mediated not by activation of the GABA_B receptor, but rather by activation of the GHB receptor. Baclofen possesses both sedative and anxiolytic properties.

Reports of overdose indicate that baclofen may cause symptoms including vomiting, general weakness, sedation, respiratory insufficiency, seizures, dizziness,{{cite web | title=Gablofen- baclofen injection injection, solution | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00d3e846-dd92-448d-9ab8-6a07be823cc1 | access-date=7 November 2021 | archive-date=12 December 2022 | archive-url=https://web.archive.org/web/20221212094154/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00d3e846-dd92-448d-9ab8-6a07be823cc1 | url-status=live }} headaches, itching, hypothermia, bradycardia, cardiac conduction abnormalities, hypertension, hyporeflexia and coma sometimes mimicking brain death.{{cite journal | vauthors = Murphy L, Wolfer H, Hendrickson RG | title = Toxicologic Confounders of Brain Death Determination: A Narrative Review | journal = Neurocritical Care | volume = 34 | issue = 3 | pages = 1072–1089 | date = June 2021 | pmid = 33000377 | pmc = 7526708 | doi = 10.1007/s12028-020-01114-y }} Overdose may require intubation and length of mechanical ventilation required may correlate with serum baclofen levels shortly after ingestion. Symptoms may persist even after the point at which serum baclofen levels are undetectable.{{cite journal | vauthors = Perry HE, Wright RO, Shannon MW, Woolf AD | title = Baclofen overdose: drug experimentation in a group of adolescents | journal = Pediatrics | volume = 101 | issue = 6 | pages = 1045–1048 | date = June 1998 | pmid = 9606233 | doi = 10.1542/peds.101.6.1045 }}

Chemically, baclofen is a derivative of the neurotransmitter γ-aminobutyric acid (GABA). It is believed to work by activating (or agonizing) GABA receptors, specifically the GABA_B receptors.{{cite web|title=Product Information Clofen|website=TGA eBusiness Services|publisher=Alphapharm Pty Limited|date=7 June 2017|url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-04975-3|access-date=15 August 2017|location=Millers Point, Australia|archive-date=15 August 2017|archive-url=https://web.archive.org/web/20170815185427/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-04975-3|url-status=live}}

Baclofen produces its effects by selectively activating the GABA_B receptor. Baclofen is postulated to block mono-and-polysynaptic reflexes by acting as an inhibitory ligand, inhibiting the release of excitatory neurotransmitters. Baclofen does not have significant affinity for the GHB receptor, and has no known abuse potential.{{cite journal | vauthors = Carter LP, Koek W, France CP | title = Behavioral analyses of GHB: receptor mechanisms | journal = Pharmacology & Therapeutics | volume = 121 | issue = 1 | pages = 100–114 | date = January 2009 | pmid = 19010351 | pmc = 2631377 | doi = 10.1016/j.pharmthera.2008.10.003 }} Agonism of GABA_B receptors is thought to be responsible for baclofen's range of therapeutic properties, as GABA_B knockout mice are unresponsive to the neurobiological effects of baclofen.{{cite journal | vauthors = Durant CF, Paterson LM, Turton S, Wilson SJ, Myers JF, Muthukumaraswamy S, Venkataraman A, Mick I, Paterson S, Jones T, Nahar LK, Cordero RE, Nutt DJ, Lingford-Hughes A | title = Using Baclofen to Explore GABA-B Receptor Function in Alcohol Dependence: Insights From Pharmacokinetic and Pharmacodynamic Measures | language = English | journal = Frontiers in Psychiatry | volume = 9 | pages = 664 | date = 2018-12-14 | pmid = 30618857 | doi = 10.3389/fpsyt.2018.00664 | doi-access = free | pmc = 6302106 }}

Similarly to phenibut (β-phenyl-GABA), as well as pregabalin (β-isobutyl-GABA), which are close analogues of baclofen, baclofen (β-(4-chlorophenyl)-GABA) has been found to block α₂δ subunit-containing voltage-gated calcium channels (VGCCs).{{cite journal | vauthors = Zvejniece L, Vavers E, Svalbe B, Veinberg G, Rizhanova K, Liepins V, Kalvinsh I, Dambrova M | title = R-phenibut binds to the α2-δ subunit of voltage-dependent calcium channels and exerts gabapentin-like anti-nociceptive effects | journal = Pharmacology, Biochemistry, and Behavior | volume = 137 | pages = 23–29 | date = October 2015 | pmid = 26234470 | doi = 10.1016/j.pbb.2015.07.014 | s2cid = 42606053 }} However, it is weaker relative to phenibut in this action (K_i = 23 and 39 μM for R- and S-phenibut and 156 μM for baclofen). Moreover, baclofen is in the range of 100-fold more potent by weight as an agonist of the GABA_B receptor in comparison to phenibut, and in accordance, is used at far lower relative dosages. As such, the actions of baclofen on α₂δ subunit-containing VGCCs are likely not clinically relevant.

For drug-reward and addiction, baclofen's mechanism of action is thought to be through its effect on the mesolimbic dopamine pathway, specifically leading to a decrease in dopamine release associated with alcohol. GABA_B receptor activation (GABA_B receptor agonist activity) may decrease or inhibit alcohol's ability to activate or fire dopaminergic neurons following exposure to alcohol. Baclofen's mechanism of action when used to treat alcohol use disorder is not thought to be mediated through its muscle-relaxing or sedative properties, however there is evidence to suggest that the GABA_B receptor-activation in the limbus may also reduce feelings of anxiety in people with alcohol use disorder.

The drug is rapidly absorbed after oral administration and is widely distributed throughout the body. Biotransformation is low: the drug is predominantly excreted unchanged by the kidneys. The serum half-life of baclofen is roughly 2–4 hours; however, one source gives a half-life of 6.8 hr, using a more complex calculation combining urinary and serum data.{{cite journal | vauthors = Wuis EW, Dirks MJ, Termond EF, Vree TB, Van der Kleijn E | title = Plasma and urinary excretion kinetics of oral baclofen in healthy subjects | journal = European Journal of Clinical Pharmacology | volume = 37 | issue = 2 | pages = 181–184 | year = 1989 | pmid = 2792173 | doi = 10.1007/BF00558228 | s2cid = 23828250 }} It therefore needs to be administered frequently throughout the day to control spasticity appropriately.

Baclofen is a white (or off-white) mostly odorless crystalline powder, with a molecular weight of 213.66 g/mol. It is slightly soluble in water, very slightly soluble in methanol, and insoluble in chloroform.

Historically, baclofen was designed as a drug for treating epilepsy. It was first synthesized at Ciba-Geigy by the Swiss chemist Heinrich Keberle in 1962.{{Cite book | vauthors= Froestl W | veditors= Blackburn TP | title= GABAb Receptor Pharmacology – A Tribute to Norman Bowery | chapter= Chemistry and Pharmacology of GABAb Receptor Ligands | series= Advances in Pharmacology | volume= 58 | pages= 19–62 | year= 2010 | isbn= 978-0-12-378647-0 | doi= 10.1016/S1054-3589(10)58002-5 | pmid= 20655477 | chapter-url= https://books.google.com/books?id=_iMDQOA2UIsC&pg=PA19 | archive-date= 29 September 2024 | access-date= 5 January 2016 | archive-url= https://web.archive.org/web/20240929051346/https://books.google.com/books?id=_iMDQOA2UIsC&pg=PA19#v=onepage&q&f=false | url-status= live }}{{cite journal | vauthors = Yogeeswari P, Ragavendran JV, Sriram D | title = An update on GABA analogs for CNS drug discovery | journal = Recent Patents on CNS Drug Discovery | volume = 1 | issue = 1 | pages = 113–118 | date = January 2006 | pmid = 18221197 | doi = 10.2174/157488906775245291 | url = http://www.bentham.org/rpcn/samples/rpcn1-1/Yogeeswari.pdf | url-status = dead | archive-url = https://web.archive.org/web/20100616045343/http://bentham.org/rpcn/samples/rpcn1-1/Yogeeswari.pdf | archive-date = 16 June 2010 }} Its effect on epilepsy was ineffective, but it was found that in certain people, spasticity decreased. In 1971, it was introduced as a treatment for certain form of spasticity. It was approved by the US Food and Drug Administration (FDA) in 1977.{{cite journal | vauthors = Romito JW, Turner ER, Rosener JA, Coldiron L, Udipi A, Nohrn L, Tausiani J, Romito BT | title = Baclofen therapeutics, toxicity, and withdrawal: A narrative review | journal = SAGE Open Medicine | volume = 9 | issue = | pages = 20503121211022197 | date = 2021 | pmid = 34158937 | pmc = 8182184 | doi = 10.1177/20503121211022197 }}

Intrathecal baclofen was first introduced in 1984 to treat severe spinal spasticity. This administration route aimed to avoid supraspinal side effects.{{cite journal | vauthors = Ochs GA | title = Intrathecal baclofen | journal = Baillière's Clinical Neurology | volume = 2 | issue = 1 | pages = 73–86 | date = April 1993 | pmid = 8143075 | doi = | url = }}{{cite journal | vauthors = Sallerin B, Lazorthes Y | title = [Intrathecal baclofen. Experimental and pharmacokinetic studies] | language = French | journal = Neuro-Chirurgie | volume = 49 | issue = 2-3 Pt 2 | pages = 271–5 | date = May 2003 | pmid = 12746702 | doi = | url = }}

In his 2008 book, Le Dernier Verre (translated literally as The Last Glass or The End of My Addiction), French-American cardiologist Olivier Ameisen described how he treated his alcoholism with baclofen. Inspired by this book, an anonymous donor gave $750,000 to the University of Amsterdam in the Netherlands to initiate a clinical trial of high-dose baclofen, which Ameisen had called for since 2004.{{cite journal | vauthors = Enserink M | title = Addiction research. Anonymous alcoholic bankrolls trial of controversial therapy | journal = Science | volume = 332 | issue = 6030 | pages = 653 | date = May 2011 | pmid = 21551041 | doi = 10.1126/science.332.6030.653 | bibcode = 2011Sci...332..653E }} The researchers concluded, "In summary, the current study did not find evidence of a positive effect of either low or high doses of baclofen in AD patients. However, we cannot exclude the possibility that baclofen is an effective medication for the treatment of severe, heavy drinking AD patients not responding to or not accepting routine psychosocial interventions."{{cite journal | vauthors = Beraha EM, Salemink E, Goudriaan AE, Bakker A, de Jong D, Smits N, Zwart JW, Geest DV, Bodewits P, Schiphof T, Defourny H, van Tricht M, van den Brink W, Wiers RW | title = Efficacy and safety of high-dose baclofen for the treatment of alcohol dependence: A multicentre, randomised, double-blind controlled trial | journal = European Neuropsychopharmacology | volume = 26 | issue = 12 | pages = 1950–1959 | date = December 2016 | pmid = 27842939 | doi = 10.1016/j.euroneuro.2016.10.006 | s2cid = 26005283 | hdl = 11245.1/cbb8e3d3-f5a2-4c1a-9e6d-f78c44e3cedb | url = https://dare.uva.nl/personal/pure/en/publications/efficacy-and-safety-of-highdose-baclofen-for-the-treatment-of-alcohol-dependence(cbb8e3d3-f5a2-4c1a-9e6d-f78c44e3cedb).html | hdl-access = free }}

File:005915731lg Baclofen 20 MG Oral Tablet.jpg

Baclofen can be administered, orally, intrathecally (directly into the cerebral spinal fluid) using a pump implanted under the skin, or transdermally as part of a pain-relieving and muscle-relaxing topical cream mix (also containing gabapentin and clonidine) prepared at a compounding pharmacy.

Intrathecal pumps offer much lower doses of baclofen because they are designed to deliver the medication directly to the spinal fluid rather than going through the digestive and blood system first. A drug concentration in the cerebrospinal fluid more than 10 times greater than when given orally is achieved with this route. At the same time the blood concentration levels are almost undetectable, thus minimizing side effects.{{cite journal | vauthors = Krach LE | title = Intrathecal baclofen use in adults with cerebral palsy | journal = Developmental Medicine and Child Neurology | volume = 51 | issue = Suppl 4 | pages = 106–12 | date = October 2009 | pmid = 19740217 | doi = 10.1111/j.1469-8749.2009.03422.x | s2cid = 20049367 | url = | doi-access = free }}

Besides those with spasticity, intrathecal administration is also used in patients with cerebral palsy or multiple sclerosis who have severe painful spasms which are not controllable by oral baclofen.{{citation needed|date=December 2022}} With pump administration, a test dose is first injected into the spinal fluid to assess the effect, and if successful in relieving spasticity, a chronic intrathecal catheter is inserted from the spine through the abdomen and attached to the pump which is implanted under the abdomen's skin, usually by the ribcage.{{citation needed|date=December 2022}} The pump is computer-controlled for automatic dosage and its reservoir can be replenished by percutaneous injection.{{citation needed|date=December 2022}} The pump also has to be replaced every five to seven years or so.{{cite web |title=Intrathecal Baclofen Therapy for Spasticity |url=http://sci.washington.edu/info/forums/reports/intrathecal_baclofen.asp |website=Northwest Regional Spinal Cord Injury System |publisher=University of Washington |access-date=21 March 2024}}

Other names include: Fleqsuvy, Gablofen, Kemstro, Lioresal, Lyvispah, Ozobax.{{Cite web |title=Baclofen |url=https://go.drugbank.com/drugs/DB00181 |access-date=2024-12-28 |website=go.drugbank.com |archive-date=1 September 2024 |archive-url=https://web.archive.org/web/20240901150353/https://go.drugbank.com/drugs/DB00181 |url-status=live }}

Baclofen is being studied for the treatment of alcoholism.{{cite journal | vauthors = Leggio L, Garbutt JC, Addolorato G | title = Effectiveness and safety of baclofen in the treatment of alcohol dependent patients | journal = CNS & Neurological Disorders Drug Targets | volume = 9 | issue = 1 | pages = 33–44 | date = March 2010 | pmid = 20201813 | doi = 10.2174/187152710790966614 }} Evidence as of 2019 is not conclusive enough to recommend its use for this purpose.{{cite journal | vauthors = Liu J, Wang LN | title = Baclofen for alcohol withdrawal | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 11 | date = November 2019 | pmid = 31689723 | pmc = 6831488 | doi = 10.1002/14651858.CD008502.pub6 }} In 2014, the French drug agency ANSM issued a three-year temporary recommendation allowing the use of baclofen in alcoholism.{{cite web | url = http://ansm.sante.fr/S-informer/Points-d-information-Points-d-information/Une-recommandation-temporaire-d-utilisation-RTU-est-accordee-pour-le-baclofene-Point-d-information | title = Une recommandation temporaire d'utilisation (RTU) est accordée pour le baclofène – Point d'information | trans-title = A temporary recommendation for use (RTU) is granted for baclofen – Information point | work = L'Agence nationale de sécurité du médicament et des produits de santé (ANSM) | trans-work = The National Agency for the Safety of Medicines and Health Products | date = 14 March 2014 | access-date = 2 March 2016 | archive-date = 7 March 2016 | archive-url = https://web.archive.org/web/20160307071205/http://ansm.sante.fr/S-informer/Points-d-information-Points-d-information/Une-recommandation-temporaire-d-utilisation-RTU-est-accordee-pour-le-baclofene-Point-d-information | url-status = live }} In 2018, baclofen received a Marketing Authorization for use in alcoholism treatment from the agency if all other treatments are not effective.{{cite web |title=Autorisation du baclofène: des conditions d'utilisation trop restrictives ? - A la une | trans-title = Authorization of baclofen: too restrictive conditions of use? - Featured |url=https://destinationsante.com/autorisation-du-baclofene-des-conditions-dutilisation-trop-restrictives.html | archive-url = https://web.archive.org/web/20181025143149/https://destinationsante.com/autorisation-du-baclofene-des-conditions-dutilisation-trop-restrictives.html | archive-date = 25 October 2018 | work = L'Agence nationale de sécurité du médicament et des produits de santé (ANSM) | trans-work = The National Agency for the Safety of Medicines and Health Products |language=fr-FR |date=25 October 2018}}

It is being studied along with naltrexone and sorbitol for Charcot–Marie–Tooth disease (CMT), a hereditary disease that causes peripheral neuropathy.{{cite journal | vauthors = Attarian S, Vallat JM, Magy L, Funalot B, Gonnaud PM, Lacour A, Péréon Y, Dubourg O, Pouget J, Micallef J, Franques J, Lefebvre MN, Ghorab K, Al-Moussawi M, Tiffreau V, Preudhomme M, Magot A, Leclair-Visonneau L, Stojkovic T, Bossi L, Lehert P, Gilbert W, Bertrand V, Mandel J, Milet A, Hajj R, Boudiaf L, Scart-Grès C, Nabirotchkin S, Guedj M, Chumakov I, Cohen D | title = An exploratory randomised double-blind and placebo-controlled phase 2 study of a combination of baclofen, naltrexone and sorbitol (PXT3003) in patients with Charcot-Marie-Tooth disease type 1A | journal = Orphanet Journal of Rare Diseases | volume = 9 | issue = 1 | pages = 199 | date = December 2014 | pmid = 25519680 | pmc = 4311411 | doi = 10.1186/s13023-014-0199-0 | doi-access = free }} It is also being studied for cocaine addiction.{{cite journal | vauthors = Kampman KM | title = New medications for the treatment of cocaine dependence | journal = Psychiatry | volume = 2 | issue = 12 | pages = 44–48 | date = December 2005 | pmid = 21120115 | pmc = 2994240 }} Baclofen and other muscle relaxants are being studied for potential use for persistent hiccups.{{cite web | url = https://www.medscape.com/viewarticle/844420 | title = What Is the Latest on Treatment for Hiccups? | publisher = Medscape | access-date = 29 July 2018 | archive-date = 16 May 2017 | archive-url = https://web.archive.org/web/20170516093749/http://www.medscape.com/viewarticle/844420 | url-status = live }}{{cite journal | vauthors = Walker P, Watanabe S, Bruera E | title = Baclofen, a treatment for chronic hiccup | journal = Journal of Pain and Symptom Management | volume = 16 | issue = 2 | pages = 125–132 | date = August 1998 | pmid = 9737104 | doi = 10.1016/S0885-3924(98)00039-6 | doi-access = free }}

From 2014 to 2017 baclofen misuse, toxicity and use in suicide attempts among adults in the US increased.{{cite journal | vauthors = Reynolds K, Kaufman R, Korenoski A, Fennimore L, Shulman J, Lynch M | title = Trends in gabapentin and baclofen exposures reported to U.S. poison centers | journal = Clinical Toxicology | volume = 58 | issue = 7 | pages = 763–772 | date = July 2020 | pmid = 31786961 | doi = 10.1080/15563650.2019.1687902 | s2cid = 208537638 | doi-access = free }}

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