Baclofen Dosing for Muscle Spasticity
The recommended initial dose of oral baclofen for treating muscle spasticity is 5 mg three times daily for 3 days, followed by gradual titration to an effective dose, typically between 40-80 mg daily. 1
Initial Dosing and Titration Schedule
- Start with 5 mg three times daily for 3 days 1
- Increase to 10 mg three times daily for 3 days 1
- Increase to 15 mg three times daily for 3 days 1
- Increase to 20 mg three times daily for 3 days 1
- Further increases may be necessary, but the total daily dose should not exceed 80 mg (20 mg four times daily) 1
Important Considerations
- The lowest dose compatible with optimal response is recommended to minimize side effects 1
- Baclofen is specifically indicated for spasticity resulting from multiple sclerosis, spinal cord injuries, and other spinal cord diseases 1
- Baclofen is not indicated for skeletal muscle spasm from rheumatic disorders, and its efficacy in stroke, cerebral palsy, and Parkinson's disease has not been established 1
- For older adults, consider starting at even lower doses (e.g., 5-10 mg/day) and titrating more slowly to minimize side effects 2
Common Side Effects and Precautions
- Main adverse effects include sedation, excessive weakness, dizziness, and mental confusion 3
- Side effects are generally dose-related, with incidence ranging from 10% to 75% 3
- Adverse effects typically appear at doses >60 mg/day 3
- Abrupt discontinuation should be avoided due to risk of withdrawal symptoms including seizures, psychic symptoms, and hyperthermia 3
- Baclofen may worsen obstructive sleep apnea by promoting upper airway collapse during sleep 4
Alternative Formulations
- Once-daily sustained-release (SR) or gastro-retentive system (GRS) formulations may be considered as alternatives to the standard three-times-daily immediate release formulation at the same total daily dose 5
- These formulations may improve medication compliance and reduce side effects 5
Intrathecal Baclofen
- For patients with severe spasticity unresponsive to maximum doses of oral baclofen, intrathecal baclofen may be considered 3
- Intrathecal baclofen has shown >80% improvement in muscle tone and >65% improvement in spasms 3
- Intrathecal administration allows for direct delivery to the cerebrospinal fluid at much lower doses than oral administration (less than 1/100 of oral doses) 6
- Candidates for intrathecal baclofen should have no contraindications to the insertion of an intrathecal catheter 6
First-Line Non-Pharmacological Approaches
- Antispastic positioning, range of motion exercises, stretching, splinting, and serial casting should be considered as first-line approaches before or alongside pharmacological treatment 2
- Physical therapy modalities may improve motor outcomes when used in conjunction with baclofen 4
Remember that individual titration is essential to determine the optimal dosage that balances efficacy and side effects for each patient with muscle spasticity.