Cauda Equina and Conus Medullaris Syndromes Medication

Updated: May 30, 2017
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
  • Print
Medication

Medication Summary

Appropriate analgesia should be provided for a patient with cauda equina syndrome. Anti-inflammatory medication may prevent worsening of injury. Anticoagulants provide prophylaxis against thrombotic complications. Use of antispasticity medications to reduce muscle tone is encouraged. Bisphosphonates may be beneficial in patients with bony lesions. Phosphodiesterase type 5 inhibitors treat erectile dysfunction (ED).

Next:

Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Methylprednisolone (DepoMedrol, Medrol, Medrol Dosepak)

This agent decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. This prevents further worsening of injury.

Treatment must be started within 8 h of injury; treatment apparently has no benefit if started later than 8 h after injury. Late treatment may have detrimental effects.

Previous
Next:

Anticoagulants

Class Summary

These agents are taken as prophylaxis for deep venous thrombosis and/or pulmonary embolism.

Heparin

Heparin augments the activity of antithrombin III and prevents conversion of fibrinogen to fibrin. It does not actively lyse clot but is able to inhibit further thrombogenesis. It prevents re-accumulation of clot after spontaneous fibrinolysis. Administer low dose.

Previous
Next:

Skeletal Muscle Relaxants

Class Summary

These agents are thought to work centrally by suppressing conduction at the spinal level.

Baclofen (Lioresal, Gablofen)

Baclofen may induce hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level.

Dantrolene (Dantrium, Revonto)

Dantrolene stimulates muscle relaxation by modulating skeletal muscle contractions at sites beyond the myoneural junction and acting directly on muscle itself. It prevents calcium release from sarcoplasmic reticulum.

Previous
Next:

Benzodiazepines

Class Summary

These agents may act in the spinal cord to induce muscle relaxation.

Diazepam (Diastat, Valium)

Diazepam depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of gamma-aminobutyric acid (GABA). Individualize dosage and increase cautiously to avoid adverse effects.

Previous
Next:

Alpha 2-adrenergic Agonist Agents

Class Summary

These agents may reduce sympathetic outflow, which may produce a reduction in muscle tone.

Clonidine (Catapres)

Clonidine stimulates alpha2-adrenoreceptors in the brain stem, activating an inhibitory neuron, which in turn results in reduced sympathetic outflow.

Tizanidine (Zanaflex)

Tizanidine is a centrally acting muscle relaxant that is metabolized in the liver and excreted in urine and feces.

Previous
Next:

Neuromuscular Blocker Agent, Toxin

Class Summary

These agents inhibit transmission of impulses in neuromuscular tissue.

OnabotulinumtoxinA (BOTOX)

This agent binds to receptor sites on motor nerve terminals and inhibits release of acetylcholine, which in turn inhibits transmission of impulses in neuromuscular tissue.

It is most useful for treating spasticity in the gastrocnemius and soleus muscles; less effective in larger muscles such as quadriceps. Re-examine patients 7-14 d after initial dose, to assess for response. It may be repeated q3-4mo.

Also indicated for urinary incontinence in patients with neurologic conditions (eg, spinal cord injury, multiple sclerosis) in adults who have an inadequate response to or are intolerant of an anticholinergic medication. Intradetrusor injections are administered about every 9 months.

Previous
Next:

Bisphosphonate Derivatives

Class Summary

These agents are analogs of pyrophosphate. They act by binding to hydroxyapatite in bone-matrix, thereby inhibiting the dissolution of crystals. They prevent osteoclast attachment to the bone matrix and osteoclast recruitment and viability.

Etidronate disodium

Etidronate inhibits normal and abnormal bone resorption. It appears to inhibit bone resorption without inhibiting bone formation and mineralization.

Alendronate (Fosamax, Binosto)

Alendronate inhibits bone resorption via actions on osteoclasts or osteoclast precursors. It is used to treat osteoporosis in both men and women and it may reduce bone resorption and incidence of fracture at spine, hip, and wrist by approximately 50%. Alendronate should be taken with a large glass of water, at least 30 min before eating and drinking, to maximize absorption. Because of possible esophageal irritation, patients must remain upright after taking the medication. Since it is renally excreted, it is not recommended in patients with moderate-to-severe renal insufficiency (ie, CrCl < 30 mL/min or CrCl >3.0 mg/dL), thus its use in perirenal transplantation is limited.

Ibandronate (Boniva)

Ibandronate inhibits osteoclast-mediated bone resorption. In postmenopausal women, it reduces bone turnover rate, leading to a net gain in bone mass.

Previous
Next:

Phosphodiesterase (type 5) Enzyme Inhibitors

Class Summary

These agents increase the vasodilatory effects of nitric oxide by inhibiting the enzyme phosphodiesterase type 5, which in turn increases sensitivity for erections.

Sildenafil (Viagra)

Sildenafil is a phosphodiesterase type 5 (PDE5) selective inhibitor. Inhibition of PDE5 increases the activity of cyclic guanosine monophosphate (cGMP), which increases the vasodilatory effects of nitric oxide. This agent is effective in men with mild-to-moderate ED.

Vardenafil (Levitra, Staxyn)

Vardenafil is a PDE5 selective inhibitor. Inhibition of PDE5 increases cGMP activity, which increases the vasodilatory effects of nitric oxide. It is effective in men with mild-to-moderate ED.

Take on an empty stomach about 1 h before sexual activity. Sexual stimulation is necessary to activate response. Increased sensitivity for erections may last 24 h. Vardenafil is available as 2.5-mg, 5-mg, 10-mg, and 20-mg tabs.

Tadalafil (Cialis)

Tadalafil is a PDE5 selective inhibitor. Inhibition of PDE5 increases cGMP activity, which increases the vasodilatory effects of nitric oxide. Sexual stimulation is necessary to activate response. Increased sensitivity for erections may last 36 h. Tadalafil is available as 2.5-mg, 5-mg, 10-mg, and 20-mg tabs.

Previous