Can Baclofen Tablets Be Crushed?
There is no specific guideline or FDA labeling information prohibiting the crushing of immediate-release baclofen tablets, and the practice appears to be feasible based on the drug's pharmacokinetic properties, though controlled-release formulations should never be crushed.
Immediate-Release Baclofen Tablets
Standard immediate-release baclofen tablets can likely be crushed when necessary for patients with swallowing difficulties, as there is no published evidence of altered bioavailability or safety concerns with this practice 1
The bioavailability of baclofen is approximately 80% and is not affected by food, suggesting the drug's absorption is not dependent on intact tablet formulation 2, 1
When crushing is necessary, administer the crushed tablet immediately after preparation, ideally mixed with a small amount of water or soft food to facilitate administration 1
Controlled-Release Formulations
Controlled-release or sustained-release baclofen formulations (SR or GRS) must never be crushed, as this would destroy the extended-release mechanism and potentially cause dangerous dose dumping 3
Once-daily baclofen SR and GRS formulations are designed to provide equivalent efficacy to three-times-daily immediate-release dosing with better tolerability 3
Important Clinical Considerations
Abrupt discontinuation of baclofen can lead to potentially life-threatening withdrawal symptoms including hallucinations, seizures, delirium, fever, and in severe cases (particularly with intrathecal baclofen), multiorgan failure and death 4
Elderly patients are at higher risk for adverse effects and typically cannot tolerate doses greater than 30-40 mg per day, with recommended starting doses of 5 mg three times daily 4
Common side effects include dizziness, somnolence, and gastrointestinal discomfort, which may be minimized by administering with meals 4, 5
Baclofen can cause increased sedation when combined with opiates or other CNS depressants 4
Practical Administration Guidance
If crushing immediate-release tablets, ensure the patient receives the full dose by using minimal liquid for mixing and having them consume all of the mixture 1
Timing adjustments such as administering with meals may reduce gastrointestinal side effects without affecting absorption 1
Any dose adjustments or discontinuation should be done gradually to minimize side effects and avoid withdrawal syndrome 4