From the Research
The maximum recommended dose of baclofen for chronic spasticity is typically 80 mg per day, divided into 3-4 doses, as supported by the most recent and highest quality study 1. However, in some cases, doses up to 120 mg daily may be used under close medical supervision. Treatment should begin with a low dose of 5 mg three times daily, gradually increasing by 5 mg per dose every 3 days until the optimal effect is achieved. Most patients respond to doses between 40-80 mg daily. Higher doses may provide additional benefit for some patients with severe spasticity but also increase the risk of side effects such as drowsiness, dizziness, weakness, and confusion. Abrupt discontinuation of baclofen should be avoided as it can cause withdrawal symptoms including hallucinations, seizures, and rebound spasticity. For patients who don't respond adequately to oral baclofen or experience intolerable side effects, intrathecal baclofen therapy via an implanted pump may be considered, which uses much lower doses delivered directly to the spinal cord, as discussed in 2 and 1. Regular monitoring for efficacy and side effects is essential throughout treatment, with consideration of the benefits and risks of oral and intrathecal baclofen, as outlined in 3.
Some key points to consider when prescribing baclofen include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for side effects, particularly at higher doses
- Avoiding abrupt discontinuation
- Considering intrathecal baclofen for patients who do not respond to or cannot tolerate oral baclofen
- Regularly reviewing the patient's response to treatment and adjusting the dose as needed, as suggested by 4 and 5.
Overall, the use of baclofen for chronic spasticity should be individualized, with careful consideration of the potential benefits and risks, and regular monitoring to ensure optimal treatment outcomes, as emphasized in 1.