From the Guidelines
Baclofen should be initiated at a low dose of 30 mg/d and titrated to effect and tolerance, with a typical range of 30 to 80 mg/d in multiple doses, as evidenced by a small RCT comparing its efficacy to botulinum toxin for spasticity management 1. The dosage and administration of Baclofen for muscle spasticity should be individualized, taking into account the patient's response and tolerance to the medication.
- The medication can be started at a dose of 30 mg/d and gradually increased until the desired effect is achieved, with most patients requiring between 30-80 mg/d.
- The dose should be divided into multiple doses, and the patient should be monitored closely for signs of toxicity or adverse effects.
- It is essential to note that Baclofen can cause withdrawal symptoms if stopped abruptly, and therefore, the dose should be gradually tapered over 1-2 weeks if discontinuation is needed.
- Common side effects of Baclofen include drowsiness, dizziness, weakness, and fatigue, which often improve with continued use or dose adjustment.
- As supported by the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines, Baclofen is an effective treatment option for spasticity, although botulinum toxin may be preferred for certain patients, particularly those with focal spasticity 1.
From the Research
Recommended Dosage and Administration of Baclofen
The recommended dosage and administration of Baclofen for muscle spasticity vary depending on the patient's condition and the route of administration.
- Oral administration: The conventional maximum daily dose is 80 mg, but some patients may require higher doses to achieve adequate symptomatic relief 2.
- Intrathecal administration: The daily dose can range from 12.5 µg to 500 µg, depending on the patient's response to the treatment 3, 4.
Factors Affecting Dosage
Several factors can affect the dosage of Baclofen, including:
- Patient's condition: The dosage may need to be adjusted based on the patient's response to the treatment and the presence of any side effects 5, 6.
- Route of administration: The dosage may vary depending on whether the Baclofen is administered orally or intrathecally 2, 4.
- Renal function: Patients with impaired renal function may require lower doses of Baclofen due to the risk of accumulation of the drug in the body 2.
Administration Options
Baclofen can be administered through various routes, including:
- Oral administration: Baclofen can be taken orally in the form of tablets or liquid 2.
- Intrathecal administration: Baclofen can be administered directly into the spinal canal using a programmable pump 5, 3, 4.
Dosing Considerations
When adjusting the dosage of Baclofen, the following considerations should be taken into account:
- Gradual dose increases: The dose should be increased gradually to minimize the risk of side effects 4.
- Monitoring: Patients should be monitored closely for signs of side effects or worsening of symptoms 4, 6.
- Individualization: The dosage should be individualized based on the patient's response to the treatment and medical history 4.