Baclofen Starting Dose for Spasticity
The recommended starting dose of baclofen (Lioresal) for treating spasticity is 5 mg up to three times daily. 1
Dosing Guidelines
- Initial dosing should be conservative at 5 mg up to three times daily to minimize side effects and optimize tolerability, especially in older adults 1
- Titration should be gradual, as older persons rarely tolerate doses greater than 30 to 40 mg per day 1
- For severe spasticity unresponsive to oral medications, intrathecal baclofen may be considered as an alternative delivery method 2
Monitoring and Precautions
- Closely monitor for muscle weakness, urinary function changes, cognitive effects, and sedation during baclofen therapy 1
- Avoid abrupt discontinuation of baclofen as it can cause central nervous system irritability and potentially severe withdrawal symptoms 1
- Be particularly cautious when using baclofen in elderly patients who may be more sensitive to side effects 3
Side Effects to Watch For
- Common adverse effects include sedation, somnolence, excessive weakness, vertigo, and psychological disturbances 4
- The incidence of adverse effects ranges from 10% to 75%, with most being dose-related, transient, and/or reversible 4
- Higher doses (>60 mg/day) are associated with increased risk of adverse effects 4
Alternative Medications for Spasticity
- Tizanidine (Zanaflex) may be considered as an alternative with a starting dose of 2 mg up to three times daily 1
- For focal spasticity, botulinum toxin may be more effective than oral baclofen 3, 2
- For generalized spasticity, if long-term continuous effect is needed, baclofen may be more suitable due to its longer duration of action 2
Special Considerations
- In patients with renal impairment, baclofen should be used with caution as it may carry an unnecessarily high risk 4
- For patients with severe spasticity who don't respond to or cannot tolerate oral baclofen, intrathecal baclofen therapy may be considered 5
- Paradoxical worsening of spasticity has been reported with higher doses in some patients, suggesting that lower doses may sometimes be more effective 6