What is the role of antispasmodics in the treatment of middle cerebral artery (MCA) stroke?

Updated: Feb 20, 2018
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Consider the use of an oral muscle relaxant if spasticity is resulting in pain or is impeding rehabilitation. CNS depression such as drowsiness and dizziness is a common adverse effect of all muscle relaxants.

Table 2. Antispasmodics Mechanisms of Action, Significant Adverse Effects, and Considerations. (Open Table in a new window)

Drug

Mechanism of Action

Significant Adverse Effect

Consideration

Baclofen

Inhibits spinal reflexes [86]

Withdrawal syndrome may include hallucinations and seizures [86]

Dose reduction may be needed with renal impairment [86]

Dantrolene

Interferes with the release of calcium from the sarcoplasmic reticulum [87]

Both diarrhea and hepatotoxicity are dose dependent and may limit use [87]

Baseline and periodic liver function tests recommended [61]

Tizanidine

Alpha2-adrenergic agonist that decreases excitatory input to alpha motor neurons [88]

Hypotension and hepatotoxicity

Withdrawal syndrome may include tachycardia and hypertonia [88]

Effect is generally only 3-6 hours, necessitating doses being reserved for times relief is needed most

Baseline and periodic liver function tests recommended

Dose reduction may be needed with renal impairment [88]


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