📋 Indications & Clinical Dosage
*Chronic severe spasticity resulting from cerebrovascular accidents, cerebral palsy, meningitis, multiple sclerosis or traumatic partial section of spinal cord and head injury:*
Adult: Initially 5 mg 3 times a day, gradually increased; maintenance up to 60 mg daily in divided doses, review treatment if no benefit within 6 weeks of achieving max. dose; max. 100 mg per day.
Children: 2.5 mg four times daily, increasing gradually at three day intervals to required daily maintenance dose: 1-2 yrs: 10-20 mg; 2-6 yr: 20-30 mg; 6-10 yr: 30-60 mg; 10-12 yrs: 60 mg; Above 12 yrs: same as adult.
*Pain of muscle spasm in palliative care:*
Adult: 5-10 mg 3 times a day.
*Hiccup due to gastric distension (in palliative care):*
Adult: 5 mg twice daily.
⛔ Contraindications
Active peptic ulceration.
⚠️ Precautions & Warnings
Cerebrovascular disease, diabetes, elderly, epilepsy, history of peptic ulcer, hypertonic bladder sphincter, Parkinsons disease, psychiatric illness, respiratory impairment, state of convulsion, hepatic or renal impairment, avoid abrupt withdrawal; may exacerbate spasticity, and precipitate autonomic dysfunction including hyperthermia, psychiatric reactions and convulsions; withdraw drug gradually over at least 1-2 weeks. Perform tests in liver disease or diabetes.
🔄 Drug Interactions
Antihypertensives, lithium, fentanyl, morphine, TCADs, ibuprofen, levodopa, carbidopa, alcohol, CNS depressants, CNS active drugs.
⚠️ Adverse Reactions / Side Effects
Agitation, anxiety, ataxia, cardiovascular depression, confusion, depression, dizziness, drowsiness, dry mouth, euphoria, GI disturbances, hallucinations, headache, hyperhidrosis, hypotension, insomnia, myalgia, nightmares, rash, respiratory depression, sedation, seizure, tremor, urinary disturbances, visual disorders, abdominal pain. Rare: changes in hepatic function, dysarthria, erectile dysfunction, paraesthesia, taste disturbances, hypothermia
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Caution advised, use only if potential benefit outweighs risk
Lactation / Breastfeeding:
Caution advised
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.