Baclofen Tapering Protocol for 15mg Daily Dose
For patients on 15mg of baclofen daily, a gradual taper of approximately 5mg (33% of original dose) per week is recommended to minimize withdrawal symptoms, with a total tapering period of 3-4 weeks.
Understanding Baclofen Withdrawal Risk
Baclofen is a GABA-B receptor agonist used to treat muscle spasticity. Abrupt discontinuation can lead to severe withdrawal symptoms including:
- Hallucinations and delirium
- Seizures
- High fever
- Agitation and anxiety
- Cardiovascular instability (hypotension, bradycardia)
- Neuropsychiatric manifestations 1, 2
These withdrawal symptoms can be severe and potentially life-threatening, as documented in case reports of patients experiencing hyperactive delirium and other serious complications following abrupt baclofen discontinuation 2.
Recommended Tapering Schedule for 15mg Daily Dose
Based on medication tapering guidelines, a structured approach is recommended:
Week 1:
- Reduce from 15mg to 10mg daily (33% reduction)
- Monitor for withdrawal symptoms
Week 2:
- Reduce from 10mg to 5mg daily
- Continue monitoring
Week 3:
- Reduce to 5mg every other day
- Continue monitoring
Week 4:
- Discontinue completely
This tapering schedule follows the principle of reducing by approximately one-third of the original dose weekly 3, which is more conservative than the general 10% monthly reduction recommended for some other medications.
Monitoring During Tapering
During the tapering process, patients should be monitored for:
- Neurological symptoms (tremors, increased muscle tone, seizures)
- Psychiatric symptoms (hallucinations, anxiety, agitation)
- Autonomic symptoms (fever, tachycardia, hypertension)
- Sleep disturbances
Management of Withdrawal Symptoms
If withdrawal symptoms occur during tapering:
- Pause the taper at the current dose until symptoms stabilize 3
- Consider a slower taper if symptoms are severe
- Adjunctive medications may be considered for symptom management:
- Benzodiazepines for severe anxiety or seizure risk (short-term use only)
- Antipsychotics for perceptual disturbances 2
Special Considerations
- For long-term users (>3 months): Consider an even more gradual taper, potentially extending to 6-8 weeks
- For patients with history of seizures: Extra caution is warranted with closer monitoring
- For elderly patients: Use a more conservative approach with smaller dose reductions
Important Cautions
- Never discontinue baclofen abruptly, as this can precipitate severe withdrawal syndrome 1, 2
- If withdrawal symptoms develop, reinstating baclofen at the previous dose and then tapering more slowly is often effective 2
- Patients should be instructed not to modify the tapering schedule without consulting their physician 3
The approach to baclofen tapering should be adjusted based on individual response, with the understanding that pauses in tapering may be necessary if withdrawal symptoms emerge 3.