Lyvispah (Baclofen) - Oral

What Is Lyvispah?

Lyvispah (baclofen) is a skeletal muscle relaxant used to relax or loosen muscle tightness related to multiple sclerosis or other spinal cord problems.

Lyvispah is categorized as a skeletal muscle relaxant that prevents the signaling of nerve reflexes in the spinal cord by binding to receptors called GABA-B. As a result, the movement of the muscles decreases.

You can get baclofen by prescription only. It is available as a tablet that you can take by mouth or an injection to be given intrathecally (injection into the spinal canal). This article will focus on the oral formulation and not the injection.

What Is Lyvispah Used For?

The Food and Drug Administration (FDA) approved Lyvispah to treat muscle spasms related to multiple sclerosis or spinal cord problems. It helps to relieve flexor spasms, which occur when the leg and hip muscles become so tight that the limbs become locked in a bent position and difficult to straighten. Lyvispah can also help with the associated pain, clonus (involuntary, rhythmic muscle contractions), and muscular rigidity.

How to Take Lyvispah

As always, you should take baclofen as instructed by your healthcare provider and follow their directions as stated.

Lyvispah comes as oral granules in a packet. Typically, dosing can range from 5 to 20 milligrams (mg) per packet. Initially, you will take Lyvispah three times a day by mouth. Your healthcare provider may increase your dosage as needed, usually by 5 milligrams while continuing at three times daily. You should not take more than 80 milligrams (the maximum dosage) per day.

The following are tips for taking the oral granules

• Empty the entire contents of the packet into your mouth. Let the granules dissolve or swallow them.
• If needed, you can take the granules with liquid or soft foods. Take one packet with up to 15 milliliters (mL) of liquid or soft foods (e.g., applesauce, yogurt, or pudding). Don't take the mixture more than two hours after mixing.
• If you are mixing more than one packet, mix each packet separately with liquid or soft food.

Additionally, Lyvispah can be given through feeding tubes.

Oral baclofen is also available as a solution (under the brand name Ozobax), suspension (under the brand name Fleqsuvy), and tablet (generic only).

Avoid drinking alcohol while taking baclofen as alcohol is a depressant that can cause worsening adverse effects. 

Storage

Store Lyvispah at room temperature (between 68 and 77 degrees F) and away from moisture. Storing your medication in hot and cold areas can prevent the medication from working correctly. As always, make sure your medication is stored in a safe place where children and pets cannot reach it.

If you need more of your medication, contact your pharmacy or prescribing healthcare provider to request a refill.

Off-Label Uses

A healthcare provider may prescribe off-label treatments when the decision is supported by scientific evidence or expert clinical experience.

Baclofen has been studied for the following off-label uses:

• Stiff person syndrome 
• Uncontrolled hiccups
• Trigeminal neuralgia (stinging pain in the facial area)
• Alcohol use disorder

Despite these indications not being approved by the FDA, there have been clinical studies showing baclofen's effectiveness and safety.

What Are the Side Effects of Lyvispah?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The side effects commonly reported with baclofen include:

• Feeling tired
• Nausea
• Headache
• Constipation
• Weakness

Severe Side Effects

Do not hesitate to contact your healthcare provider right away if you are experiencing any of these rare but severe side effects. Call 911 immediately if your symptoms feel life-threatening or you think you need medical assistance.

Rare but severe side effects associated with baclofen include:

• Fainting or passing out
• Confusion
• Seizures
• Balance or posture changes
• Depression
• High blood pressure
• Ovarian cysts
• Increased seizures in people with epilepsy

It is important to continue taking baclofen until your healthcare provider tells you to stop. Suddenly stopping this medication can worsen your symptoms or cause the following side effects:

• Increased muscle stiffness
• Itching
• Tingling in hands and feet
• Seizures
• Hallucinations
• Confusion
• High blood pressure
• High fever
  

Dosage: How Much Lyvispah Should I Take?

Modifications

Oral baclofen is available in the following formulations:

• Granule (Lyvispah)
• Solution (Ozobax)
• Suspension (Fleqsuvy)
• Tablet (generic only)

Initially, the dosage for baclofen for children ranges between 10 to 80 milligrams daily, depending on the child’s age. If your child has difficulty swallowing medication, you can talk to their healthcare provider about either using the liquid formulation or mixing the granules with liquid or soft food (e.g., yogurt, pudding, or applesauce). You can crush the tablet and mix it with no more than 1 tablespoon of food.

Baclofen can also be administered through a feeding tube.

Before starting baclofen, talk to your healthcare provider if you:

• Are pregnant: Withdrawal symptoms have been reported in infants born to pregnant people treated with baclofen.
• Are breastfeeding or plan to breastfeed: Baclofen can pass through human breast milk.
• Have poor kidney function: Notifying your healthcare provider about your kidney function will allow them to adjust the dosage to your needs.

It would help if you also told your healthcare provider about other health conditions so that they can monitor your treatment with baclofen accordingly.

Missed Dose

If you happen to miss a dose, don't panic. Take the missed dose as soon as you remember. Do not take more than prescribed at one time to make up for the missed dose, as this can increase the chances of unwanted side effects.

Overdose: What Happens If I Take Too Much Lyvispah?

The results of a published study determined that the average amount of baclofen leading to an overdose was about 200 milligrams or greater. People who were admitted to the hospital after taking more than the recommended dosage experienced the following symptoms:

• Seizures 
• Loss of consciousness
• Mental confusion
• Slow breathing rate
• Coma

Taking excess Lyvispah, whether intentionally or accidentally, can lead to severe side effects and even death.

Precautions

What Are Reasons I Shouldn’t Take Lyvispah?

You should not take Lyvispah:

• To treat muscle spasms related to joint problems
• If you have been diagnosed with cerebral palsy, Parkinson's disease, or a stroke
• If you have had a previous allergic reaction to baclofen
  

What Other Medications Interact With Lyvispah?

When taking Lyvispah, you must be aware of medications or supplements that can make your side effects worse or reduce how well the drug works.

Avoid taking any baclofen product with central nervous system (CNS) depressant medications. Baclofen and CNS depressants both decrease the activity of the nervous system. Therefore, taking both at the same time can slow breathing and lead to unresponsiveness or severely low blood pressure.

Common CNS depressants include:

• Benzodiazepines, such as Halcion (triazolam) and Restoril (temazepam)
• Other types of prescribed sleeping medications, such as Ambien (zolpidem) and Belsomra (suvorexant)
• Opioids, such as hydrocodone and fentanyl

What Medications Are Similar?

Other than baclofen, other medications that can be used to treat muscle spasms related to spinal injuries include:

• Zanaflex (tizanidine)
• Flexeril (cyclobenzaprine)
• Skelaxin (metaxalone)
• Chlorzoxazone

Zanaflex

Tizanidine, or Zanaflex, is an effective and safe treatment for muscle spasms related to the spinal cord. Tizanidine activates receptors in your brain that prevent the release of chemicals that cause muscle movement. As a result, muscle contraction decreases. With regard to efficacy and safety, there is no significant difference between baclofen and tizanidine. Tizanidine may be the second drug of choice if you have trouble tolerating baclofen.

Flexeril

Like baclofen, cyclobenzaprine (available under the brand name Flexeril) is also considered a skeletal muscle relaxant. However, Flexeril treats muscle spasms related to muscle and bone issues, not the spine. Lyvispah is preferred as the first line of treatment for muscle spasms over Flexeril, especially for nerve injuries.

Skelaxin

Skelaxin (metaxalone) is a prescription medication that relieves symptoms from acute, painful musculoskeletal conditions. Although both metaxalone and baclofen are muscle relaxers, metaxalone is typically used short-term, whereas baclofen is used for people dealing with chronic muscle spasticity problems.

Chlorzoxazone

Chlorzoxazone, like metaxalone, is a muscle relaxant used to treat painful musculoskeletal conditions.

This list is a list of drugs belonging to the same therapeutic class as Lyvispah. It is NOT a list of drugs recommended to take with Lyvispah. Ask your pharmacist or a healthcare provider if you have questions.

How Can I Stay Healthy While Taking Lyvispah?

To stay healthy while taking baclofen, it is important to take this medication as instructed by your healthcare provider. Do not stop taking the medication even if you feel better unless you are told to do so by your healthcare provider.

Try to avoid strenuous activities or lifting heavy objects during treatment. If your job requires you to do so, don't hesitate to inform your manager about your condition. Straining your muscles may slow your progress to feeling better. Your healthcare provider can let you know what level of activity and lifestyle change would be right for you.

Acknowledgement

The author would like to recognize and thank Alexya Rosas for contributing to this article.