Baclofen, Botox, and More: 5 Cerebral Palsy Medications for Spasticity

Cerebral palsy is a complex condition that develops during childhood. It can affect multiple aspects of daily life, including movement as well as balance, speech, and vision. While cerebral palsy can look different for everyone, increased muscle tone is a common symptom. This is known as spasticity — stiff muscles that can make it difficult to move.

Spasticity can affect specific limbs, sides of the body, or even multiple body areas. Fortunately, medications — from pills to injections — are available to help relax stiff muscles. Whether you’re living with cerebral palsy or caring for someone who is, it’s good to understand your options. Below are five cerebral palsy medications for spasticity your healthcare provider may consider.

1. Baclofen

Baclofen is a muscle relaxant that calms down the overactive nerve signals that cause spasticity. It’s one of the most widely used oral medications for spasticity for cerebral palsy in children and adolescents. However, this is considered an off-label use. This means that the FDA hasn’t approved oral baclofen specifically for this reason.

Many people take baclofen by mouth as a tablet. Oral liquids (Fleqsuvy, Ozobax) are also available for those who have difficulty taking pills or who use a G-tube (feeding tube). The most common oral baclofen side effect is drowsiness. Confusion and dizziness are also possible.

Baclofen can also be given through an intrathecal pump, which injects the medication into the fluid surrounding the spinal cord. Intrathecal baclofen is approved for severe spasticity from cerebral palsy in people ages 4 and older. It’s used when people have spasticity that affects many muscles in their body.

The intrathecal pump used to deliver the medication is implanted under the skin during a surgical procedure. It can provide higher doses needed for relief, while lowering the risk of drowsiness. You can also adjust the dose throughout the day for symptom control.

Good to know: If you stop taking baclofen abruptly, withdrawal symptoms are possible — sometimes within hours of stopping it. This can range from fever and worsening spasticity to hallucinations and seizures. Symptoms can be more severe with intrathecal baclofen. To avoid this, be sure to take baclofen as prescribed and keep up with prescription (or pump) refills on time.

2. Botox

Botox (onabotulinumtoxinA) is a toxin made from bacteria that blocks nerve signals where it’s injected. While many people are familiar with Botox injections for wrinkles, it’s also a useful cerebral palsy medication.

When given for spasticity, Botox is injected into the affected muscles. This temporarily relaxes them and reduces stiffness. These effects usually last around 3 months. Botox is approved for this use in people ages 2 and older.

Since Botox only works where it’s injected, it’s usually not ideal for generalized spasticity. In this case, an oral or intrathecal medication may be a better alternative. But it can be a good option if only a few muscles are affected by spasticity or if one muscle group is tighter than others. Other treatments, including physical therapy and bracing, are typically used along with Botox injections for the best results.

After receiving Botox, the muscles where it was injected may be very weak. But this side effect is usually temporary. Injection site pain and cold symptoms are also common side effects. Unlike baclofen and the other oral medications on this list, Botox does not cause drowsiness.

Good to know: Botox doesn’t work for everyone. And its effects usually only last for a few months, so you may need repeat injections as the prior doses wear off. A small study found that Botox might not work as well for spasticity symptoms after the first few injections.

3. Tizanidine

Tizanidine (Zanaflex) is an oral muscle relaxant. It reduces spasticity by blocking nerve signals that cause muscle contractions. Tizanidine comes as a tablet and capsule. When prescribed for children, this is considered an off-label use. That’s because tizanidine is only approved for adults.

Similar to baclofen, drowsiness is common after taking tizanidine. Withdrawal symptoms can also happen if it’s stopped abruptly. Tizanidine can also cause low blood pressure, especially if taken with interacting medications. And while rare, it has been linked to liver damage.

Good to know: For people who have difficulty swallowing pills, tizanidine capsules can be opened and sprinkled onto soft food, such as applesauce. It can also be mixed with water and given via a G-tube. However, food can affect how the body absorbs tizanidine. So it’s best to pick one way to take tizanidine — on an empty stomach or with food — and stick with it.

4. Dantrolene

Dantrolene (Dantrium) is an oral medication. It works by acting on the muscle fibers themselves, reducing the intensity of muscle contractions. If other spasticity medications haven’t worked well enough, dantrolene may be an option. It’s approved for use in both adults and children.

Dantrolene can cause drowsiness, along with dizziness, weakness, and fatigue. Diarrhea is also common. These side effects usually happen in the beginning of treatment and tend to improve over time. But if spasticity symptoms aren’t improving after 45 days of treatment, dantrolene may be discontinued.

Good to know: Dantrolene has a boxed warning (the FDA’s strictest warning) for liver damage. This appears to be more likely in women, people over 35 years old, and those taking dantrolene with other medications that are hard on the liver. Because of this, liver health is normally watched closely during treatment.

5. Diazepam

Diazepam (Valium) is a benzodiazepine medication. It works by relaxing muscles, which can help lessen spasticity. Diazepam is approved for spasticity in people ages 6 months and older. It comes as a tablet and an oral solution.

Similar to other oral spasticity medications, diazepam can cause drowsiness and dizziness. It’s also a controlled substance, which means it has a risk of misuse and dependence. Withdrawal symptoms are also possible if it’s stopped too quickly. Because of these risks, it’s usually recommended to only take diazepam for a short period of time.

Good to know: Both anxiety and seizures are common in people living with cerebral palsy. Diazepam has a calming effect on the central nervous system, which can help reduce anxiety and improve seizure control.

Deciding between medications

There’s no “one-size-fits-all” medication for spasticity. As covered above, there are several factors to consider when selecting the right treatment, such as:

• Limbs, regions, or body areas affected: Since oral medications work throughout the body, they may be preferred if spasticity symptoms are widespread. But targeted treatments, like Botox, can be a better fit if only specific areas are affected.

• Ability to take pills: For people who have trouble taking pills by mouth, both baclofen and diazepam are available as oral liquids. Tizanidine capsules can be opened and sprinkled onto soft food. You may also be able to administer some of the oral medications through a feeding tube, if one is required.

• Symptom severity: Severe spasticity symptoms may require higher medication doses, which can make oral options difficult to tolerate. In this case, intrathecal baclofen may be considered.

• Related conditions or symptoms: Some medications can be useful for related conditions or symptoms beyond spasticity. For example, diazepam may be considered if anxiety or seizures also require treatment.

Spasticity treatment often involves striking the right balance between an effective medication dose and side effects. In other words, it should provide relief while still allowing people to function in their daily lives.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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