From the Guidelines
Baclofen withdrawal should never be attempted without a gradual tapering regimen under medical supervision to avoid potentially life-threatening withdrawal symptoms. According to the most recent and highest quality study, 1, abrupt cessation of baclofen can cause significant morbidity and even death, similar to other central nervous system depressants.
Key Considerations for Baclofen Withdrawal
- The risk of withdrawal symptoms is high when stopping or significantly reducing baclofen, and these symptoms can include increased spasticity, hallucinations, confusion, agitation, seizures, hyperthermia, and in severe cases, rhabdomyolysis or multiple organ failure.
- A comfortable and safe tapering regimen should be offered to patients to reduce or discontinue long-term opioid therapy (LTOT) or other central nervous system depressants like baclofen, as recommended by 1.
- The tapering regimen should be individualized, typically reducing the dose by 5-10mg every 3-7 days, depending on the patient's current dosage and response.
- A slower taper may be needed for patients on higher doses or those who have been taking baclofen long-term, as they are at a higher risk of experiencing severe withdrawal symptoms.
Management of Withdrawal Symptoms
- If withdrawal symptoms occur, immediate medical attention is necessary, and the medication may need to be reinstated, as stated in 1.
- Patients should be educated about the risks of baclofen withdrawal before starting therapy and should never adjust their dosage without consulting their healthcare provider.
- Clinicians should be aware of the potential for withdrawal symptoms and use validated scales to monitor patients, such as the Clinical Opiate Withdrawal Scale or the Clinical Institute Narcotic Assessment scale, although these are not specific for baclofen withdrawal, as mentioned in 1.
From the FDA Drug Label
WARNINGS a. Neonatal Withdrawal Symptoms:Withdrawal symptoms have been reported starting hours to days after delivery in neonates whose mothers were treated with oral baclofen throughout pregnancy. b. Abrupt Drug Withdrawal:Hallucinations and seizures have occurred on abrupt withdrawal of baclofen Therefore, except for serious adverse reactions, the dose should be reduced slowly when the drug is discontinued.
Baclofen withdrawal can cause severe symptoms, including:
- Hallucinations
- Seizures
- Increased muscle tone
- Tremor
- Jitteriness To avoid these symptoms, the dose should be reduced slowly when the drug is discontinued, except in cases of serious adverse reactions 2.
From the Research
Baclofen Withdrawal Symptoms
- Hallucinations, delirium, seizures, and high fever can occur as a result of severe baclofen withdrawal syndrome 3
- Abrupt reduction in gamma-aminobutyric acid(B) (GABA) agonist activity in the central nervous system can cause the intrathecal baclofen (ITB) withdrawal syndrome, which is clinically and pathophysiologically distinct from autonomic dysreflexia, malignant hyperthermia, and neuroleptic-malignant syndrome 4
- Baclofen withdrawal syndrome can manifest as hallucinosis and/or seizures with abrupt reduction of dose or discontinuation of baclofen therapy 5
Prevention and Management of Baclofen Withdrawal
- Tapering the dose of baclofen gradually after long-term administration can prevent severe withdrawal symptoms 5
- Restoration of ITB therapy can interrupt the ITB withdrawal syndrome, and supportive measures and high-dose benzodiazepine infusion may be life-saving in the interval before ITB therapy is resumed 4
- Patients at risk can be identified and educated prospectively and given medication for emergency use, and treatment with GABAergic agonist drugs may prevent potentially fatal sequelae 4
Relationship to Other Substances
- Benzodiazepines, which are used to treat anxiety, spasticity, and epilepsy, can cause severe withdrawal symptoms similar to those of baclofen, and require careful tapering of the medication when prescribed 6
- High-dose baclofen has been shown to reduce agitation-related events in patients with unhealthy alcohol use receiving mechanical ventilation, but further research is needed to determine its possible role in this setting 7