Skelaxin vs. Baclofen
See how Skelaxin and Baclofen compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Skelaxin treats acute musculoskeletal pain while baclofen treats spasticity from multiple sclerosis or spinal cord conditions, so the two drugs are prescribed for different problems despite both being called muscle relaxants.
Baclofen requires a gradual dose increase over about nine days and should never be stopped abruptly, while Skelaxin is started at its full working dose from day one.
Baclofen typically costs far less out of pocket than Skelaxin, but it carries a serious withdrawal risk that metaxalone does not.
Skelaxin vs. Baclofen Drug Summary
Skelaxin
Skelaxin (metaxalone) is a skeletal muscle relaxant used alongside rest and physical therapy for acute, painful musculoskeletal conditions. It's an oral tablet, usually dosed at 800 mg three to four times a day, and absorbs better when taken with a high-fat meal. It carries no boxed warning and is approved for adults and adolescents 13 and older.
Baclofen
Baclofen is a GABA-B receptor agonist used to treat spasticity from multiple sclerosis, spinal cord injury, or other spinal cord disease. It comes as a tablet, solution, or granules, starting at a low dose and stepping up over about nine days to a maintenance dose. Severe, treatment-resistant spasticity can also be managed with an intrathecal pump delivered directly into the spinal fluid.
Skelaxin vs. Baclofen Side Effects
Skelaxin
Baclofen
Skelaxin vs. Baclofen Dosage
Skelaxin
Baclofen
| STAGE | DOSE | WHEN |
| Starting dose | 800 mg 3-4 times daily | At the start |
| Maximum dose | 800 mg 3-4 times daily | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg three times daily | Days 1-3 |
| Maximum dose | 20 mg three times daily | Day 10 onward |
| Dose changes | 3 increases | Every 3 days |
Skelaxin
| STAGE | DOSE | WHEN |
| Starting dose | 800 mg 3-4 times daily | At the start |
| Maximum dose | 800 mg 3-4 times daily | Same as starting |
| Dose changes | None | Fixed dose |
Baclofen
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg three times daily | Days 1-3 |
| Maximum dose | 20 mg three times daily | Day 10 onward |
| Dose changes | 3 increases | Every 3 days |
Skelaxin vs. Baclofen Indications
Skelaxin
Skelaxin is FDA-approved as an adjunct to rest and physical therapy for acute, painful musculoskeletal conditions in adults and adolescents 13 and older. It's meant for short-term relief of muscle spasm and discomfort rather than ongoing spasticity management. It's not approved for children 12 and under.
Acute, painful musculoskeletal conditions
Used with rest and physical therapy
Approved for adults and ages 13 and up
Not approved for children 12 and under
Baclofen
Baclofen is FDA-approved to reduce spasticity caused by multiple sclerosis, spinal cord injury, or other spinal cord disease, and severe cases can be treated with an intrathecal pump. It's also used off-label for alcohol cravings, hiccups, and GERD, though those uses aren't FDA-approved. It hasn't been shown effective for spasticity from stroke, cerebral palsy, or Parkinson's disease.
Spasticity from multiple sclerosis
Spasticity from spinal cord injury or disease
Severe spasticity via intrathecal pump
Off-label: alcohol cravings, hiccups, GERD
Skelaxin vs. Baclofen Pros and Cons
Skelaxin
Skelaxin has no boxed warning and doesn't require a titration schedule, so treatment starts at the full working dose right away. It's contraindicated in severe kidney or liver impairment, and absorption depends on taking it with a high-fat meal.
Pros
No boxed warning
No titration needed, starts at full dose
Lower risk of dangerous withdrawal on stopping
Cons
Higher list price than baclofen
Absorption depends on a high-fat meal
Contraindicated in severe renal or hepatic impairment
Not approved for children 12 and under
Baclofen
Baclofen has decades of clinical use, comes in several forms including tablets, solution, and an intrathecal pump, and costs much less out of pocket than Skelaxin. It requires a step-up dosing schedule and must be tapered carefully, since stopping suddenly can trigger seizures or rebound spasticity.
Pros
Much lower list price than Skelaxin
Multiple formulations for flexible dosing
Long track record of use since 1977
Cons
Abrupt stopping can cause dangerous withdrawal
Requires gradual titration over 9+ days
Not proven effective for stroke or CP spasticity
Needs dose adjustment in renal impairment
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