From the Research
The recommended dose of baclofen for adults with muscle spasticity is typically started at 5 mg three times daily, gradually increasing by 5 mg every three days as needed and tolerated, up to a usual maximum of 80 mg daily. For children, dosing is typically weight-based and should be determined by a pediatrician 1. Baclofen should be started at a low dose and increased gradually to minimize side effects such as drowsiness, dizziness, and weakness. The medication works by acting on GABA-B receptors in the spinal cord to reduce the release of excitatory neurotransmitters, thereby decreasing muscle tone and spasticity.
Some key points to consider when prescribing baclofen include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for side effects such as drowsiness, dizziness, and weakness
- Avoiding sudden cessation of the medication to prevent withdrawal symptoms
- Considering dose adjustments for elderly patients or those with renal impairment
- Taking the medication with food to reduce gastrointestinal side effects
It's also important to note that the efficacy of baclofen compared to other skeletal muscle relaxants has been studied, with fair evidence suggesting that baclofen, tizanidine, and dantrolene are effective compared to placebo in patients with spasticity 1. However, the most recent and highest quality study should be prioritized when making a definitive recommendation. In this case, the study by 2 suggests that combination of botulinum toxin type A with oral tizanidine may be more effective with fewer side effects than combination of botulinum toxin type A and oral baclofen for spastic cerebral palsy.
Overall, the key to effective treatment with baclofen is careful dose titration and monitoring for side effects, as well as consideration of individual patient factors and the specific condition being treated.