From the Guidelines
Baclofen should be initiated at a low dose of 5 mg three times daily and gradually increased by 5 mg every 3 days until optimal response is achieved, usually between 40-80 mg per day divided into three or four doses, as supported by the most recent evidence from 2025 1.
Key Considerations
- The maximum recommended daily dose is 80 mg, though some patients may require up to 120 mg in severe cases.
- For intrathecal administration, patients usually begin with a test dose of 50-100 mcg, and if effective, an implantable pump is used for continuous delivery, with maintenance doses typically ranging from 12-1500 mcg/day based on individual response.
- Patients should be monitored for side effects including drowsiness, dizziness, weakness, and nausea, which are most common during initial titration.
- Abrupt discontinuation must be avoided as it can cause hallucinations, seizures, and rebound spasticity; tapering should occur over 1-2 weeks.
- Baclofen works by activating GABA-B receptors in the spinal cord, inhibiting the release of excitatory neurotransmitters and reducing muscle tone.
- Treatment effectiveness should be assessed regularly through functional improvement and spasticity reduction, with dose adjustments made accordingly.
Comparison with Other Treatments
- Evidence supports the use of botulinum toxin for patients with focal spasticity depending on patient characteristics and preferences, with no significant difference found between botulinum toxin and oral baclofen in any outcome except ankle spasticity, which favored botulinum toxin 1.
- The choice between baclofen and other treatments, such as tizanidine and dantrolene, should be based on individual patient needs and preferences, as well as the specific characteristics of each medication 1.
From the Research
Recommended Dosage and Treatment Protocol for Baclofen
The recommended dosage and treatment protocol for Baclofen in managing muscle spasticity vary depending on the patient's condition and response to the medication.
- The initial dosage of oral Baclofen is typically 5 mg three times a day, with gradual increases as needed and tolerated 2.
- The maximum recommended dose of oral Baclofen is 80 mg per day 2.
- For intrathecal Baclofen, the dosage is typically adjusted individually based on the patient's response, with a usual range of 50-1000 mcg per day 3.
Administration and Monitoring
- Baclofen can be administered orally or intrathecally, with the latter being more effective for severe spasticity [(3,2)].
- Close monitoring is necessary to adjust the dosage and prevent side effects, such as muscle weakness, nausea, and somnolence [(3,2)].
- Patients receiving intrathecal Baclofen require regular follow-up to monitor the pump and catheter, as well as to adjust the dosage as needed 3.
Comparison with Other Treatments
- Baclofen is comparable to other antispasmodic agents, such as tizanidine and diazepam, in terms of efficacy [(4,5,6)].
- Intrathecal Baclofen may be a viable option for patients who experience intolerable side effects or fail to respond to oral Baclofen 2.
- Other treatments, such as gabapentin and botulin toxin, may also be effective in managing spasticity [(5,6)].