From the Guidelines
Baclofen withdrawal symptoms typically peak between 1-3 days after the abrupt cessation of intrathecal baclofen infusion. This is based on the most recent evidence from a 2020 study published in the journal Anaesthesia 1. The study highlights the importance of recognizing and treating intrathecal baclofen withdrawal syndrome promptly to prevent catastrophic outcomes. Key factors to consider in the management of baclofen withdrawal include:
- The risk of severe withdrawal symptoms, including autonomic instability and seizures, which can be life-threatening if not recognized and treated promptly
- The need for immediate resumption of intrathecal baclofen infusion, or alternative supportive measures such as high-dose benzodiazepine intravenous infusion or oral baclofen, to manage withdrawal symptoms
- The importance of gradual tapering of baclofen doses to prevent withdrawal symptoms, rather than abrupt cessation of therapy. In clinical practice, it is essential to be aware of the potential for baclofen withdrawal and to take steps to prevent it, particularly in patients who are at high risk of withdrawal due to high doses or prolonged use of the medication.
From the FDA Drug Label
WARNINGS ... b. Abrupt Drug Withdrawal: Hallucinations and seizures have occurred on abrupt withdrawal of baclofen Therefore, except for serious adverse reactions, the dose should be reduced slowly when the drug is discontinued.
The peak time for Baclofen withdrawal is not explicitly stated in the drug label.
- No specific time frame is provided for the peak of withdrawal symptoms.
- The label does advise to reduce the dose slowly when discontinuing the drug to avoid severe withdrawal symptoms, such as hallucinations and seizures 2.
From the Research
Baclofen Withdrawal Syndrome
- The peak time for Baclofen withdrawal syndrome is not explicitly stated in the provided studies, but the duration of withdrawal symptoms can vary from a few days to several weeks or even months 3, 4, 5, 6.
- Severe baclofen withdrawal syndrome can manifest within 12 hours to a few days after an abrupt decrease in the dose of baclofen or disruption of intrathecal baclofen delivery 3, 4, 6.
- Symptoms of baclofen withdrawal can include hallucinations, delirium, seizures, high fever, increased spasticity, agitation, hypertension, and tachycardia 3, 4, 5, 6.
- The management of baclofen withdrawal typically involves gradual dose reduction, oral baclofen replacement, and adjunctive administration of parenteral gamma-aminobutyric acid agonists or other medications such as benzodiazepines and opiates 4, 6.
- In some cases, replacement of the baclofen pump and restoration of intrathecal delivery of the medication may be necessary to trigger recovery and complete reversal of the withdrawal syndrome 6.