From the Guidelines
Baclofen withdrawal should never be stopped abruptly as it can cause serious and potentially life-threatening withdrawal symptoms, and a gradual tapering regimen under medical supervision is always recommended. Patients on baclofen should be tapered off gradually to avoid significant morbidity and even death, as highlighted in a 2020 study published in the Mayo Clinic Proceedings 1. The study emphasizes the importance of a comfortable and safe tapering regimen when reducing or discontinuing long-term opioid therapy, and this consideration applies even more to central nervous system depressants like baclofen.
Some key points to consider when tapering baclofen include:
- Reducing the dose by 5-10mg every 3-7 days, depending on the starting dose and individual response
- Beginning with 10mg reductions weekly for higher doses (e.g., 80mg daily), then slowing to 5mg reductions as the dose gets lower
- Monitoring for withdrawal symptoms, which can include increased spasticity, hallucinations, seizures, high fever, altered mental status, and in severe cases, rhabdomyolysis or multiple organ failure
- Recognizing that withdrawal symptoms typically begin within 24-48 hours of stopping or significantly reducing the medication and can progress rapidly
- Providing immediate medical attention to anyone experiencing baclofen withdrawal symptoms
The severity of withdrawal relates to baclofen's mechanism as a GABA-B receptor agonist; when removed suddenly, the inhibitory effects are lost, leading to neuronal hyperexcitability similar to other sedative-hypnotic withdrawals, as noted in the context of avoiding abrupt cessation of central nervous system depressants like baclofen 1. Patients with kidney impairment may need even more gradual tapering as baclofen clearance is reduced in these individuals. A gradual tapering regimen under medical supervision is essential to minimize the risk of serious withdrawal symptoms and ensure a safe transition off baclofen.
From the FDA Drug Label
WARNINGS a. Neonatal Withdrawal Symptoms:Withdrawal symptoms have been reported starting hours to days after delivery in neonates whose mothers were treated with oral baclofen throughout pregnancy. 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.
Baclofen withdrawal can cause severe symptoms, including hallucinations and seizures. To avoid these symptoms, the dose of baclofen should be reduced slowly when the drug is discontinued, except in cases of serious adverse reactions 2.
- Neonatal withdrawal symptoms can also occur in infants born to mothers who were treated with oral baclofen throughout pregnancy.
- Slow withdrawal is recommended to minimize the risk of withdrawal symptoms.
From the Research
Baclofen Withdrawal Symptoms
- High fever, altered mental status, and profound muscular rigidity can occur in patients who experience abrupt withdrawal of intrathecal baclofen (ITB) therapy 3
- Hallucinosis and/or seizures can develop with abrupt reduction of dose or discontinuation of baclofen therapy 4
- Baclofen withdrawal is associated with numerous complications, including respiratory failure, refractory seizures, delirium, and blood pressure lability 5
Treatment Options for Baclofen Withdrawal
- Restoration of ITB therapy can interrupt the withdrawal syndrome 3
- Supportive measures and high-dose benzodiazepine infusion may be life-saving in the interval before ITB therapy is resumed 3
- Dantrolene infusion may relieve muscle rigidity but does not reverse the other manifestations of GABAergic agonist withdrawal 3
- Administration of other pharmacologic adjuncts, such as benzodiazepines, propofol, skeletal muscle relaxants, and tizanidine, may be required to effectively treat associated withdrawal symptoms 6, 5