Do You Need To Taper Baclofen?

dtknoxville asked

Can you build a tolerance to Baclofen? I have been on 30-60 mg. daily for 2 years, and I don’t think it helps anymore. Should I titrate downward slowly, or would 1 month be sufficient? Thank you!

Answer

Baclofen is a skeletal muscle relaxant, structurally similar to GABA (gamma-aminobutyric acid), a prominent inhibitory neurotransmitter.

It is indicated to treat spasticity, muscle spasms, myoclonus, and muscle rigidity. It can improve mobility in individuals with multiple sclerosis and also improve bowel and bladder function.

Abruptly stopping baclofen can cause withdrawal symptoms, and therefore, tapering is often recommended.

Baclofen Tolerance

Multiple studies have reported that individuals can develop a tolerance to baclofen, meaning that it can lose effectiveness over time, requiring dose escalation or a change to alternative medications for better effect.

Doses of baclofen are generally initiated around 5 mg per dose, up to three times daily.

However, doses up to 80 mg/day can be used, which is the listed maximum daily dose by the FDA. However, studies have reported doses up to 150 mg/day can be given safely to some patients with severe symptoms.

Baclofen Withdrawal

Abrupt discontinuation of baclofen is associated with withdrawal symptoms. To avoid this, it is generally recommended to taper your dose slowly, over a period of at least a couple of weeks. Per the prescribing information for baclofen:

"Following abrupt withdrawal of LIORESAL (baclofen), delirium, visual and auditory hallucinations, convulsion (status epilepticus), dyskinesia, confusional state, psychotic disorder, mania or paranoia, anxiety with tachycardia and sweating, insomnia, rhabdomyolysis and worsening of spasticity have occurred. Therefore, except for serious adverse reactions, the dose should be reduced slowly when the drug is discontinued (over a period of approximately 1-2 weeks)."

Withdrawal symptoms of baclofen can appear quickly after abrupt discontinuation, within a few hours to a few days. Reported symptoms include:

• Worsening of spasticity
• Delirium
• Hallucinations
• Confusion
• Seizures
• Movement disorders
• Psychosis
• Paranoia
• Mania
• Anxiety
• Tachycardia (increased heart rate)
• Sweating
• Insomnia
• Pruritus (itching)
• Hypotension (low blood pressure)

Both oral and intrathecal baclofen therapy are associated with withdrawal reactions but intrathecal withdrawal is particularly associated with potentially severe reactions, including:

• Rhabdomyolysis
• Autonomic dysreflexia
• Neuroleptic malignant syndrome

How To Taper Baclofen

As mentioned, it is not recommended to stop baclofen suddenly. Most sources state that it should be tapered slowly over at least 1 to 2 weeks to avoid or reduce the severity of withdrawal symptoms.

There is no 'one' specific recommended taper and the method chosen should be based on a discussion with your doctor and requires monitoring.

While tapering, it is important to be aware of the potential withdrawal symptoms. If they occur and are severe, a return to a previously well-tolerated dose can help alleviate them which should then be followed by a more conservative taper.

Be sure to discuss how to safely taper and discontinue baclofen with your doctor as they have your complete medical history.