Management of Muscle Spasm

First-Line Treatment Options

The American College of Physicians recommends baclofen (10-30 mg/day) as a first-line treatment for muscle spasms, particularly effective in patients with chronic conditions 1
Tizanidine is recommended as an alternative first-line agent, especially for chronic stroke patients with spasticity, by the American Heart Association 2
Non-pharmacological interventions such as stretching, massaging the affected muscles, and application of ice should accompany drug therapy, as suggested by the American College of Physicians 1

The American Geriatrics Society recommends that muscle relaxants should generally be avoided in elderly patients due to increased risk of falls, sedation, and anticholinergic effects 3
The American Heart Association recommends tizanidine, dantrolene, and oral baclofen for spasticity resulting in pain, poor skin hygiene, or decreased function in stroke patients 2
Diazepam and other benzodiazepines should be avoided during stroke recovery due to possible deleterious effects on recovery, as advised by the American Heart Association 2

Carisoprodol should be avoided due to concerns about drug abuse potential, as warned by the American College of Physicians 3
All muscle relaxants may cause central nervous system events such as somnolence, fatigue, and lightheadedness, according to the American College of Physicians 4

The American College of Physicians advises to never abruptly discontinue muscle relaxants after prolonged use, and to implement a slow tapering period to prevent withdrawal symptoms, particularly with baclofen 1
A slow tapering period is recommended to prevent withdrawal symptoms when discontinuing muscle relaxants, as suggested by the American College of Physicians 3