Baclofen Dosage for Adults with Spasticity
The recommended dosage of baclofen for adults with spasticity 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: 5-10 mg three times daily (15-30 mg/day)
- Titration schedule: Increase by 5 mg per dose (15 mg/day) every 3 days 1
- Target dose range: 30-60 mg/day in divided doses 1
- Maximum dose: Up to 80 mg/day in some cases 1
Dosing Algorithm
- Start with 5 mg TID (especially for post-stroke spasticity) 1
- Assess response after 3 days
- If inadequate response and no significant side effects, increase by 5 mg per dose
- Continue titration every 3 days until:
- Adequate spasticity control is achieved
- Maximum recommended dose is reached (80 mg/day)
- Side effects limit further dose increases
Special Populations
- Patients with liver disease: Use standard doses for mild-moderate disease; for severe liver disease, use more gradual dose titration 1
- Patients with renal impairment: Dose adjustment required as baclofen is primarily excreted by the kidneys 1
- Patients with neurogenic bladder: Monitor renal function and baclofen levels, as blood levels may rise over time due to impaired renal clearance 2
Alternative Formulations
- Once-daily formulations: Sustained release (SR) and gastric retentive system (GRS) formulations can be used at the same total daily dose as immediate release, improving compliance and reducing side effects 3
- Intrathecal baclofen: Consider for severe spasticity not responding to oral therapy 1, 4
- Starting dose: Twice the effective bolus screening dose
- For adults: Daily dose increases of 5-15% for cerebral-origin spasticity and 10-30% for spinal-origin spasticity 4
Side Effects and Monitoring
- Common side effects: Drowsiness, dizziness, weakness, and fatigue 1
- Monitor for excessive sedation, particularly during dose titration 1
- Nystagmus may occur at higher concentrations 5
Important Precautions
- Never discontinue baclofen abruptly due to risk of withdrawal syndrome 1
- When discontinuing, taper gradually over at least 1-2 weeks 1
- For patients unable to take oral medication, IV baclofen may be considered (at approximately 80% of the oral dose) to prevent withdrawal 5
Clinical Pearls
- The pharmacokinetics of high-dose baclofen may differ from standard doses, with longer time-to-peak plasma levels and longer half-lives 2
- Baclofen blood levels may rise gradually over time in some patients on a stable dosing regimen, particularly those with potential renal insufficiency 2
- Assessment should occur within 24 hours of any dose change to monitor for efficacy and side effects 4