Baclofen Tapering Protocol
For baclofen tapering, a gradual reduction of approximately 10% of the most recent dose per week for shorter-term users (less than 1 year) and 5-10% per month for long-term users is recommended to minimize withdrawal symptoms. 1
Tapering Schedule Based on Duration of Use
Short-term users (less than 1 year)
- Reduce dose by approximately 10% of the most recent dose per week
- Example: 30mg daily → 27mg daily for one week → 24.3mg daily for next week
Long-term users (1 year or more)
- Reduce dose by 5-10% of the most recent dose per month
- Example: 30mg daily → 27-28.5mg daily for one month → 24.3-25.7mg daily for next month
Important Considerations
- Never abruptly discontinue baclofen as this can result in a potentially severe withdrawal syndrome 2
- Withdrawal symptoms may include agitation, hallucinations, anxiety, insomnia, and in severe cases, seizures or death 3
- Each percentage reduction should be calculated from the most recent dose, not the original starting dose 1
- The target dose may not be zero for all patients 3
Managing Withdrawal Symptoms
If withdrawal symptoms occur during tapering, consider:
- Temporarily pausing the taper at the current dose until symptoms resolve
- Slowing the taper rate (e.g., from 10% to 5% reductions)
- Pharmacological management of specific symptoms:
- Clonidine for sympathetic hyperactivity
- Gabapentin for insomnia and anxiety
- NSAIDs/Acetaminophen for pain 1
Special Populations
- Patients with liver cirrhosis: Baclofen has been shown to be effective in maintaining alcohol abstinence in patients with liver cirrhosis 3, but may require more careful monitoring during tapering
- Patients on intrathecal baclofen: Require specialized tapering protocols under supervision of specialists familiar with intrathecal delivery systems 4
Monitoring and Follow-up
- Regular follow-up at least monthly during the tapering process
- Monitor for withdrawal symptoms at each visit
- Assess need for adjunctive treatments to manage withdrawal symptoms
- Consider more frequent monitoring for high-risk patients (elderly, those with comorbid conditions)
Bridging Options
If oral therapy needs to be interrupted, intravenous baclofen may be feasible as a bridge with approximately 20% dose reduction (IV dose = 80% of oral dose) due to the 80% oral bioavailability of baclofen 2
Resuming Treatment if Needed
Some patients whose regimens have been tapered to elimination may benefit from resumption at lower doses if symptoms recur 3
Remember that successful tapering requires patient engagement, clear communication about expectations, and a supportive approach to managing withdrawal symptoms.