(FDA approved in bold)

• Acute and intermittent management of increased muscle tone related to spasticity
  
• Spasticity can result from neurological conditions, such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), primary lateral sclerosis, and spinal cord injury
  
• Migraine prophylaxis
  
• Neck pain/lower back pain
  
• Myofascial pain

• Alpha-2 adrenergic agonist (mostly at alpha-2A receptors) which also acts at imidazoline receptors. Reduces spasticity by increasing presynaptic inhibition of motor neurons

• Pain – hours-weeks

• Slowly titrate to most effective tolerated dose

• Increase to highest tolerated dose. If ineffective, gradually reduce dose and consider alternative medications

• Botulinum toxin is effective, especially as an adjunct for focal spasticity, i.e., post-stroke or head injury affecting the upper limbs. For conditions with multiple areas of spasticity, i.e., cerebral palsy, this combination can be very useful
  
• May be used carefully in combination with baclofen, although additive sedation can be problematic
  
• Use other centrally acting muscle relaxants with caution due to potential additive CNS depressant effect

• Monitor liver and renal function at baseline and at 1, 2, and 3 months. Monitor hepatic enzymes at 6 months and periodically after that