CBD and Muscle Relaxants (e.g. Lioresal, Baclofen-ratiopharm)

If you are taking baclofen (e.g. Lioresal, baclofen-ratiopharm) and are considering using CBD (cannabidiol), it is important to understand possible interactions and safety aspects. This article explains what is currently known about combining CBD with baclofen, where the main risks may lie, and what cautious use can look like – with a focus on CBD and muscle relaxants.

Can I combine CBD with baclofen (Lioresal)?

CBD and baclofen can sometimes be used together, but only with care. The most relevant interaction is a potentially additive depressant effect on the central nervous system (CNS) – meaning more tiredness, dizziness, muscle weakness and slower reactions. Because baclofen is mainly excreted via the kidneys, possible effects of CBD on liver enzymes are considered less important here than the risk of increased sedation.

• Risk level: low–moderate (primarily potential CNS depression)
• Monitor: sleepiness, dizziness, muscle weakness, confusion
• Seek medical advice: in case of pronounced tiredness, breathing difficulties, falls or confusion

What is baclofen and how does it work?

Baclofen as a centrally acting muscle relaxant

Baclofen is a centrally acting muscle relaxant that activates GABA-B receptors in the spinal cord. This dampens the transmission of signals that can trigger muscle spasticity. It is often used in spastic conditions associated with neurological disorders and may indirectly ease discomfort by reducing muscle tension.

Common side effects and warnings

• Tiredness, drowsiness, dizziness
• Muscle weakness, low blood pressure
• Nausea, gastrointestinal complaints
• Important: Do not stop baclofen suddenly (there is a risk of withdrawal symptoms such as restlessness, confusion or seizures). Any changes should only be made in consultation with your doctor.

What is CBD and how does it work?

CBD is a non-intoxicating compound from the cannabis plant. It interacts with the endocannabinoid system and other signalling pathways that are associated with processes such as pain perception, mood and sleep – without the “high” of THC. Read more here about how CBD works in the body

Relevant CBD side effects when taking baclofen

• Common: sleepiness, dry mouth, dizziness
• Occasional: gastrointestinal symptoms (e.g. diarrhoea), changes in appetite/weight
• Rare (especially at higher doses/medicinal CBD): changes in liver values – other medicines should be taken into account

Interactions: CBD + baclofen

CNS effects: why sedation is the main concern

Both CBD and baclofen can dampen activity in the central nervous system. When used together, there may be an increased likelihood of sleepiness, dizziness, impaired coordination and muscle weakness. This may:

• increase the risk of falls
• slow reaction times
• affect the ability to drive or operate machinery safely

This potential CNS depressant effect of CBD in combination with baclofen is considered the most clinically relevant interaction.

Metabolism: CBD, liver enzymes and baclofen excretion

Many CBD drug interactions involve effects on liver enzymes such as CYP3A4 and CYP2C19, which play a role in the metabolism of various prescription medicines. CBD can inhibit these enzymes and thereby influence how other medicines are broken down.

Baclofen, however, is largely excreted unchanged via the kidneys and is only to a limited extent metabolised by liver enzymes. For this reason, the frequently discussed CBD liver enzyme effects and CYP inhibition (e.g. CBD and CYP3A4) are considered less relevant for baclofen than for many other medicines. In practice, what matters most is careful clinical monitoring for signs of increased sedation and muscle weakness when CBD is added.

Practical tip: Start with a low CBD dose, consider a 2–3 hour interval between CBD and baclofen doses, and avoid additional sedating substances (alcohol, benzodiazepines, opioids). More on CBD interactions

You can check other potential CBD drug interactions with your medicines here:

Background on CBD interactions (professional information/label): EMA product information cannabidiol (Epidyolex): epidyolex – ema.europa.eu

Using CBD cautiously with baclofen: step by step

Starting dose and slow increase

• Begin with a very low CBD dose (e.g. 5–10 mg/day) and keep this dose for 3–4 days.
• If well tolerated, increase slowly in small steps (e.g. +5–10 mg), again keeping each level for 3–4 days.
• Keep a brief symptom diary for 1–2 weeks (tiredness, dizziness, muscle strength, sleep, gastrointestinal symptoms).

Dosing interval, alcohol and driving

• Dosing interval: a 2–3 hour gap between baclofen and CBD may help separate peak CNS effects in time.
• Avoid alcohol and be cautious with other CNS depressants (e.g. sleeping tablets, benzodiazepines, opioids).
• Driving/operating machinery: only if you feel alert and safe. Do not drive if you feel tired, light‑headed or slowed down.

Monitoring for side effects

• Unusual or pronounced daytime sleepiness or dizziness
• Muscle weakness, unsteady gait, near‑falls or falls
• Confusion or concentration problems
• At higher CBD doses: gastrointestinal complaints (e.g. diarrhoea, nausea); rarely altered liver values – seek medical assessment if you develop symptoms suggestive of liver problems.

Who should be particularly cautious with CBD and baclofen?

• Older adults (increased risk of falls and confusion)
• Impaired kidney function (baclofen is renally excreted)
• Sleep apnoea or chronic respiratory conditions
• Polypharmacy (use of other CNS‑depressant prescription medicines)
• People with a history of dizziness or falls

Comparison: CBD vs baclofen vs combination

When to seek medical advice

• Severe or persistent sleepiness, dizziness or drowsiness
• Marked muscle weakness, unsteadiness when walking or falls
• Breathing difficulties, confusion or unusual changes in behaviour
• New or worsening gastrointestinal complaints

Product quality and usage notes

• Choose low‑THC, laboratory‑tested CBD products with a certificate of analysis (COA).
• Use a consistent concentration and preferably the same manufacturer to minimise variability.
• Follow the recommended dosage and avoid taking more than directed.
• If you use CBD products alongside baclofen, opt for high‑quality CBD and pay close attention to how you tolerate them.

Summary

CBD and baclofen (e.g. Lioresal, baclofen‑ratiopharm) can sometimes be used together, but only with caution. The key consideration is potential additive CNS depression (tiredness, dizziness, muscle weakness and slower reactions). The widely discussed effects of CBD on liver enzymes (CYP inhibition) are considered less relevant for baclofen, as it is mainly excreted via the kidneys. If you decide to try CBD:

• start with a low dose and increase slowly
• consider a 2–3 hour dosing interval between CBD and baclofen
• avoid alcohol and other sedating substances
• seek medical advice if you experience marked side effects or feel unsure.

Disclaimer: This article is for information purposes only and does not replace medical advice. Do not change medicines or dosages without consulting your doctor. No claims are made regarding the treatment or cure of illnesses.