Baclofen Dosing Recommendations
The recommended dosing for baclofen is 5-10 mg three times daily, with a typical effective total daily dose of 30-60 mg, though dosing should be adjusted based on indication, patient factors, and liver function. 1
General Dosing Guidelines
- Standard baclofen dosing ranges from 15-60 mg per day, with most patients responding in the 30-60 mg range 1, 2
- Initial dosing should start at 5-10 mg three times daily, with gradual titration to minimize side effects 1
- For alcohol use disorder, baclofen can be prescribed up to 80 mg/day as recommended by its marketing authorization 3
- Once-daily formulations (sustained release or gastro-retentive systems) may be acceptable alternatives to thrice-daily immediate release formulations at the same total daily dosage 4
Special Population Considerations
- In elderly patients, lower starting doses (5 mg twice daily) are recommended due to increased sensitivity to side effects 1, 2
- For patients with severe liver disease, a more gradual dose increase is recommended, though the presence of liver disease generally does not affect prescribing baclofen at doses up to 80 mg/day 3
- Patients with renal impairment require dose adjustment as baclofen is primarily excreted by the kidneys 2, 5
- Baclofen blood levels may rise gradually over time in patients on stable dosing regimens, particularly those with impaired renal function 5
Indication-Specific Dosing
- For alcohol use disorder maintenance therapy, low-dose baclofen (30 mg daily) has shown efficacy in maintaining abstinence 2, 6
- For hiccups, the titration of baclofen can be increased weekly by 10 mg/day up to 30 mg/day if needed 1
- For intrathecal administration in severe spasticity, much lower doses are used (less than 1/100th of oral doses), with individualized programming of the pump 7, 8
Monitoring and Side Effects
- Common side effects include sedation, drowsiness, dizziness, and muscle weakness 1, 2
- Monitor for cognitive impairment, muscle weakness, and urinary dysfunction, particularly in older adults 1
- Avoid abrupt discontinuation as it may cause central nervous system irritability 1
- For patients on high-dose therapy, monitoring of plasma levels may be useful, particularly for those with potential renal insufficiency 5
Pharmacokinetic Considerations
- Time-to-peak plasma levels and plasma half-lives may be longer than previously reported, particularly with high-dose therapy 5
- Baclofen clearance from cerebrospinal fluid occurs with a half-life of approximately 5 hours 8
- The therapeutic window varies significantly between individuals, making careful titration from low doses essential 2