Recommended Dosage of Baclofen for Adults with Spasticity
For adults with spasticity, the recommended dosage of baclofen is 30-60 mg per day, typically starting at 5-10 mg three times daily and gradually increasing to the effective dose. 1
Initial Dosing and Titration
- Starting dose: 5 mg three times daily (15 mg/day)
- Titration schedule: Increase by 5 mg per dose (15 mg/day) every 3 days
- Target dose range: 30-60 mg/day in divided doses 1
- Maximum dose: Up to 80 mg/day may be considered in some cases 1
Administration Schedule
- Standard immediate-release formulation: Administer three times daily
- Sustained-release or gastro-retentive formulations: May be administered once daily at the same total daily dose 2
Dosing Considerations for Specific Conditions
Stroke-Related Spasticity
- Oral baclofen is an appropriate option for post-stroke spasticity 1
- Consider starting at the lower end of the dosing range (5 mg TID)
- Tizanidine may be considered as an alternative in chronic stroke patients 1
Spinal Cord-Related Spasticity
- May require higher doses within the 30-60 mg/day range
- Intrathecal baclofen should be considered for severe spasticity not adequately controlled with oral therapy 1, 3
Special Populations
Patients with Hepatic Impairment
- Baclofen can generally be used at standard doses in patients with liver disease 1
- For severe liver disease, a more gradual dose titration is recommended 1
Patients with Renal Impairment
- Dose adjustment required as baclofen is primarily excreted by the kidneys
- Monitor for signs of toxicity in patients with impaired renal function 4
Monitoring and Side Effects
- Common side effects: Drowsiness, dizziness, weakness, fatigue
- Monitor for excessive sedation, particularly during dose titration
- For muscle cramps as a side effect, albumin infusion or dose adjustment may be needed 1
Treatment Duration and Discontinuation
- Long-term therapy is often required for chronic spasticity
- Never discontinue baclofen abruptly due to risk of withdrawal syndrome
- When discontinuing, taper gradually over at least 1-2 weeks
Alternative Formulations
- Intrathecal baclofen: Consider for severe spasticity not responding to oral therapy 1, 3
- Sustained-release formulations: Allow once-daily dosing with similar efficacy to immediate-release formulations 2
Common Pitfalls to Avoid
- Initiating at too high a dose, leading to excessive sedation
- Inadequate dose titration, resulting in suboptimal spasticity control
- Abrupt discontinuation, which can lead to severe withdrawal symptoms
- Failure to adjust dosing in patients with renal impairment
- Not considering intrathecal baclofen for patients with severe spasticity unresponsive to oral therapy
Baclofen remains one of the most widely used and effective treatments for spasticity of various origins, with a well-established dosing protocol that balances efficacy and tolerability.