What is the safest way to taper off 0.5 milligrams (mg) of baclofen?

Baclofen Tapering Protocol for 0.5 mg Dose

For a 0.5 mg dose of baclofen, the safest approach is to reduce by approximately 0.125 mg (25% of the dose) every 2 weeks until discontinuation, with careful monitoring for withdrawal symptoms. 1

Understanding Baclofen Withdrawal Risk

Even at low doses like 0.5 mg, abrupt discontinuation of baclofen carries risks:

• The FDA warns that abrupt withdrawal can cause hallucinations and seizures 2
• Withdrawal symptoms can include agitation, anxiety, insomnia, and in severe cases, seizures 1
• The risk of withdrawal is proportional to duration of use, with longer-term users requiring slower tapering

Recommended Tapering Schedule for 0.5 mg

1. Initial phase: Reduce from 0.5 mg to 0.375 mg daily for 2 weeks
2. Middle phase: Reduce to 0.25 mg daily for 2 weeks
3. Final phase: Reduce to 0.125 mg daily for 2 weeks
4. Discontinuation: Stop completely after 2 weeks at 0.125 mg

For patients who have been on baclofen for less than 1 year, this 6-week schedule is appropriate. For long-term users (>1 year), consider extending each phase to 4 weeks for a more gradual taper 1.

Practical Implementation

Since baclofen tablets typically come in 10 mg or 20 mg strengths:

• Use a pill cutter to divide tablets
• Consider a compounding pharmacy for precise small doses
• Alternatively, use a liquid formulation if available for more precise dosing

Monitoring for Withdrawal Symptoms

Watch for these key withdrawal signs:

• Increased muscle tone or spasticity
• Anxiety or agitation
• Insomnia
• Tremors
• Hallucinations
• Seizures (rare but serious)

Managing Withdrawal Symptoms

If withdrawal symptoms occur:

• Temporarily pause the taper at the current dose until symptoms resolve
• Resume tapering at a slower rate (e.g., 10% reduction instead of 25%)
• Consider non-pharmacological approaches for symptom management:
  • Regular exercise
  • Stress management techniques
  • Sleep hygiene practices 1

Special Considerations

• Liver disease: Patients with impaired renal function may require even slower tapering as baclofen is primarily excreted through the kidneys 2
• Pregnancy: Gradual reduction is especially important before delivery to prevent neonatal withdrawal symptoms 2
• Multiple medications: If the patient is taking other medications associated with withdrawal (e.g., benzodiazepines), each medication requires its own specific tapering schedule 1

When to Seek Medical Help

Advise patients to seek immediate medical attention if they experience:

• Severe anxiety or agitation
• Hallucinations
• Seizures
• Any other concerning symptoms

Following this protocol will minimize the risk of withdrawal symptoms while safely discontinuing baclofen at the 0.5 mg dose level.