Tapering Baclofen After Two Weeks of Use
After only two weeks of baclofen use for lumbar radiculopathy, you should still taper the medication rather than stop abruptly, though the taper can be much faster than for long-term users—typically reducing the dose by 25-50% every 2-3 days over approximately one week. 1, 2
Why Tapering is Necessary Even After Short-Term Use
The FDA drug label explicitly warns that "hallucinations and seizures have occurred on abrupt withdrawal of baclofen" and states "the dose should be reduced slowly when the drug is discontinued" without specifying a minimum duration threshold. 2 This warning applies broadly to baclofen discontinuation regardless of treatment duration, as withdrawal symptoms can emerge even after relatively brief exposure to GABA-B receptor agonists. 1, 2
The Mayo Clinic guidelines specifically recommend continuing baclofen preoperatively "including the day of operation" because "significant withdrawal symptoms have been reported following abrupt discontinuation" including visual and auditory hallucinations, anxiety, agitation, delirium, fever, tremors, tachycardia, and seizures. 1
Recommended Tapering Protocol for Short-Term Use
For a patient who has used baclofen for only two weeks:
- Reduce the dose by 25-50% every 2-3 days rather than stopping abruptly 1, 2
- Complete the taper over approximately 5-7 days (much faster than the months-long tapers required for chronic users) 1
- Monitor for withdrawal symptoms including anxiety, tremor, hallucinations, or seizures during the taper 1, 2, 3
Critical Distinction from Long-Term Use
The American Geriatrics Society guidelines emphasize that "discontinuation after prolonged use should be carefully managed" with a "slow tapering period," but this refers specifically to chronic users. 1 After only two weeks, the risk of severe withdrawal is substantially lower than in long-term users, but not absent. 1, 2
Case reports document hallucinations occurring 23-31 hours after abrupt baclofen discontinuation in surgical patients, which resolved after reinstituting the medication. 3 These cases underscore that even preoperative discontinuation requires gradual withdrawal rather than abrupt cessation. 1, 3
Practical Implementation
- If the patient is taking 10 mg three times daily (30 mg/day): Reduce to 10 mg twice daily for 2-3 days, then 10 mg once daily for 2-3 days, then discontinue 1, 2
- If taking higher doses: Use proportional reductions maintaining the same timeline 1
- Restart immediately if withdrawal symptoms emerge and slow the taper further 2, 3
Special Considerations for Older Adults
In older adults with lumbar radiculopathy, baclofen carries additional risks including dizziness, somnolence, and falls. 1 The American Geriatrics Society notes that muscle relaxants "may be associated with greater risk for falls in older persons," making careful discontinuation even more important to avoid compounding risks with withdrawal symptoms. 1
Alternative treatments such as acetaminophen, topical analgesics, or physical therapy should be considered as safer options for ongoing pain management in this population. 1