What is the role of baclofen in the treatment of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Answer

Baclofen may be effective in patients with trigeminal neuralgia. [43, 44] Tizanidine was investigated in a few trials but did not show significant benefit. Commonly, baclofen is added to anticonvulsants when breakthrough symptoms occur.

In an early small, uncontrolled study, Fromm et al demonstrated baclofen to be useful. [15] Of the 14 patients with idiopathic trigeminal neuralgia resistant to carbamazepine, 10 found relief with 60-80 mg/d of baclofen. [15] The starting dosage is 10 mg/d, which can be increased, if needed, to 60-80 mg/d administered 3-4 times per day (it has a short half-life of 3-4 h). [15] According to Parekh et al and Raskin, the dose of carbamazepine then may be reduced to 500 mg/d to maintain a putative synergistic effect. [41, 45]

In another study, Fromm and Terrence suggested that L-baclofen represents a significant improvement over racemic baclofen in the treatment of trigeminal neuralgia. [46]


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