What is the role of benzodiazepines in the treatment of spasticity?

Updated: Jun 28, 2019
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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The benzodiazepines bind in the brainstem and at the spinal cord level and increase the affinity of gamma-aminobutyric acid (GABA) for the GABA-A receptor complex. This results in an increase in presynaptic inhibition and then reduction of monosynaptic and polysynaptic reflexes. These drugs may improve passive range of motion and reduce hyperreflexia, painful spasms, and anxiety.

Diazepam has a half-life of 20-80 hours and forms active metabolites that prolong its effectiveness. The half-life of clonazepam ranges from 18-28 hours.

Benzodiazepines should be started at low dosages and increased slowly. In adults, diazepam can be started at 5 mg at bedtime, and if daytime therapy is indicated, the dosage can be increased slowly to 60 mg/day in divided doses. Clonazepam can be started at 0.5 mg at night and slowly increased to a maximum of 20 mg/day in 3 divided doses.

Sedation, weakness, hypotension, adverse gastrointestinal effects, memory impairment, incoordination, confusion, depression, and ataxia may occur. Tolerance and dependency can occur, and withdrawal phenomena, notably seizures, have been associated with abrupt cessation of therapy. Patients who are taking benzodiazepines with agents that potentiate sedation and have central depressant properties (eg, baclofen or tizanidine) should be monitored carefully.

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