From the Guidelines
You should taper off baclofen rather than stopping it abruptly to avoid potential withdrawal symptoms and reduce the risk of morbidity and mortality. When discontinuing baclofen, a gradual reduction over a period of 1-2 weeks is typically recommended 1. For example, if you're taking 20mg three times daily, you might reduce by 5mg per dose every 3 days until you're completely off the medication. Abrupt discontinuation of baclofen can lead to withdrawal symptoms including hallucinations, confusion, agitation, seizures, and in severe cases, a condition resembling neuroleptic malignant syndrome 1. These withdrawal effects occur because your body becomes accustomed to the GABA-B receptor activity that baclofen provides, and sudden removal can cause neurological hyperexcitability. The longer you've been taking baclofen and the higher your dose, the more important a careful taper becomes. Always consult with your healthcare provider before changing your baclofen regimen, as they can create a personalized tapering schedule based on your specific situation and medical history. Some studies suggest that tapering opioids first might be safer when patients are taking both opioids and benzodiazepines or other central nervous system depressants, including baclofen 1. However, the most recent and highest quality study emphasizes the importance of avoiding abrupt withdrawal of baclofen and other central nervous system depressants 1. Key considerations for tapering baclofen include:
- Gradual reduction of the dose over 1-2 weeks
- Close monitoring for withdrawal symptoms
- Personalized tapering schedule based on individual patient factors
- Consultation with a healthcare provider before changing the baclofen regimen.
From the FDA Drug Label
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.
- Tapering off baclofen is recommended to avoid potential withdrawal symptoms such as hallucinations and seizures.
- The dose should be reduced slowly when the drug is discontinued, except in cases of serious adverse reactions. 2
From the Research
Baclofen Withdrawal Syndrome
- Baclofen withdrawal syndrome can occur when the medication is stopped abruptly, leading to severe symptoms such as hallucinations, delirium, seizures, and high fever 3, 4, 5.
- The risk of withdrawal syndrome is greater with intrathecal baclofen, but it can also occur with oral baclofen 6, 7.
- Symptoms of baclofen withdrawal syndrome can be difficult to distinguish from delirium of other etiologies, and unrecognized and inadequately treated baclofen-withdrawal delirium is associated with significant morbidity and mortality 5.
Tapering Off Baclofen
- Tapering off baclofen slowly is recommended to prevent withdrawal syndrome 4, 7.
- Abrupt discontinuation of baclofen can lead to severe withdrawal symptoms, and reinstating the medication can help alleviate these symptoms 3, 5.
- A gradual tapering schedule can help minimize the risk of withdrawal syndrome, but the optimal tapering schedule is not well established 6.
Management of Baclofen Withdrawal Syndrome
- Re-initiation or supplementation of baclofen dosing is the most effective treatment for baclofen withdrawal syndrome 7.
- Symptomatic management with antipsychotics and benzodiazepines may also be necessary to manage associated withdrawal symptoms 4, 5.
- Supportive interventions to reduce complications of delirium, such as hydration and monitoring, are also important in the management of baclofen withdrawal syndrome 5.