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The precise mechanism of action of Lioresal is not fully knownLioresal is capable of inhibiting both monosynaptic and polysynaptic reflexes at the spinal levelpossibly by hyperpolarization of afferent terminalsalthough actions at supraspinal sites may also occur and contribute to its clinical effectAlthough Lioresal is an analog of the putative inhibitory neurotransmitter gamma-aminobutyric acidGABAthere is no conclusive evidence that actions on GABA systems are involved in the production of its clinical effectsIn studies with animalsLioresal has been shown to have general CNS depressant properties as indicated by the production of sedation with tolerancesomnolenceataxiaand respiratory and cardiovascular depressionLioresal is rapidly and extensively absorbed and eliminatedAbsorption may be dose-dependentbeing reduced with increasing dosesLioresal is excreted primarily by the kidney in unchanged form and there is relatively large intersubject variation in absorption and/or elimination.

Lioresal is indicated for the relief of spasticity of voluntary muscle resulting from such disorders asmultiple sclerosisother spinal lesionse.gtumours of the spinal cordsyringomyeliamotor neurone diseasetransverse myelitistraumatic partial section of the cord.

Precautions in special patient populationsCareful dose titration of LIORESAL INTRATHECAL is needed when spasticity is necessary to sustain upright posture and balance in locomotion or whenever spasticity is used to obtain optimal function and care.

WithdrawalAbrupt withdrawal of intrathecal baclofenregardless of the causehas resulted in sequelae that included high feveraltered mental statusexaggerated rebound spasticity and muscle rigiditythat in rare cases progressed to rhabdomyolysismultiple organ-system failureand deathIn the first 9 years of post-marketing experience27 cases of withdrawal temporally related to the cessation of baclofen therapy were reportedsix patients diedIn most casessymptoms of withdrawal appeared within hours to a few days following interruption of baclofen therapyCommon reasons for abrupt interruption of intrathecal baclofen therapy included malfunction of the catheterespecially disconnectionlow volume in the pump reservoirand end of pump battery lifehuman error may have played a causal or contributing role in some casesCases of intrathecal mass at the tip of the implanted catheter leading to withdrawal symptoms have also been reportedmost of them involving pharmacy compounded analgesic admixturessee PRECAUTIONS

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