What is a good starting dose of baclofen for a patient with leg contracture inhibiting physical therapy who weighs 102 pounds?

Starting Dose of Baclofen for Leg Contracture

Start with baclofen 5 mg three times daily (15 mg total daily dose) and titrate upward every 3 days based on response and tolerability. 1

FDA-Approved Dosing Protocol

The FDA label for oral baclofen provides a specific titration schedule that should be followed 1:

• Days 1-3: 5 mg three times daily (15 mg/day total)
• Days 4-6: 10 mg three times daily (30 mg/day total)
• Days 7-9: 15 mg three times daily (45 mg/day total)
• Days 10-12: 20 mg three times daily (60 mg/day total)
• Further increases: May continue as needed, but maximum daily dose should not exceed 80 mg/day 1

Why This Conservative Approach Matters

For a patient weighing 102 lbs (46 kg), starting at the lowest FDA-recommended dose of 5 mg three times daily is particularly important because 2:

• Oral baclofen may cause significant sedation in stroke patients 2
• Smaller patients are at higher risk for dose-dependent side effects including somnolence, dizziness, and mental clouding 2
• The patient's contracture is already inhibiting physical therapy, so excessive sedation or weakness would further impair rehabilitation efforts 2

Clinical Context for Contracture Management

Baclofen is specifically recommended by the American Heart Association for spasticity resulting in decreased function, which includes contractures that inhibit therapy 2, 3. However, medication should be combined with non-pharmacological approaches 2, 3:

• Antispastic positioning performed several times daily 2, 3
• Range of motion exercises 2, 3
• Stretching protocols 2, 3
• Consider splinting or serial casting for contractures interfering with function 2

Target Dose Range

The usual effective dose range is 40-80 mg daily in divided doses 1. For this 102-lb patient:

• Assess response at each titration step before advancing 1
• The lowest dose compatible with optimal response should be used 1
• Many patients achieve benefit at doses lower than the maximum 80 mg/day 1

Critical Safety Considerations

Monitor closely for these dose-limiting adverse effects 2:

• Sedation and drowsiness (most common) 2
• Excessive muscle weakness that could worsen functional status 2
• Dizziness or mental confusion 2
• In patients with any renal impairment, start at even lower doses as baclofen requires renal elimination 2

When to Reassess the Approach

If benefits are not evident after a reasonable trial period at adequate doses, slowly withdraw the drug rather than continuing indefinitely 1. Consider alternative approaches if 2, 3:

• Spasticity remains problematic despite oral baclofen at 60-80 mg/day
• Side effects prevent adequate dosing
• Functional goals are not being met

In such cases, consider botulinum toxin injections for focal spasticity or consultation for intrathecal baclofen in chronic cases 2, 3.