Faculty Collaboration Database

Best Practices for Intrathecal Baclofen Therapy: Dosing and Long-Term Management. Neuromodulation 2016 Aug;19(6):623-31

Date

07/20/2016

Pubmed ID

27433993

DOI

10.1111/ner.12388

Scopus ID

2-s2.0-84981736920 (requires institutional sign-in at Scopus site)   65 Citations

Abstract

INTRODUCTION: Intrathecal baclofen (ITB) therapy aims to reduce spasticity and provide functional control.

METHOD: An expert panel consulted on best practices.

RESULTS: Pump fill and drug delivery can be started intraoperatively, with monitoring for at least eight hours. Initiate with the 500 mcg/mL concentration. The starting daily dose should be twice the effective bolus screening dose, or the screening dose if the patient had a prolonged response (greater than eight hours) or negative reactions. Oral antispasmodics can be weaned, one drug at a time beginning with oral baclofen after ITB begins. Assessment should occur within 24 hours of a dose change. For adults, daily dose increases may be 5% to 15% once every 24 hours for cerebral-origin spasticity and 10% to 30% once every 24 hours for spinal-origin spasticity. Daily dose increases can be 5% to 15% once every 24 hours for children. Inpatients should be assessed at least every 24 hours and receive rehabilitation. Step dosing can be used for outpatients who cannot return daily. Dosing options include simple continuous dosing, variable 24-hour flex dosing, or regularly scheduled boluses. Patients/caregivers should understand the care plan, responsibilities, and possible side-effects. Low-reservoir alarm dates and refill schedules should be written down, along with emergency contact information. A higher concentration at refill can extend refill intervals, and a bridge bolus must be programmed. Time changes may affect flex dosing. Pump replacement should be scheduled at least three months in advance.

CONCLUSIONS: ITB dosing is multistep and individualized.

Author List

Boster AL, Adair RL, Gooch JL, Nelson ME, Toomer A, Urquidez J, Saulino M

Author

Mary Elizabeth S. Nelson-Biersach DNP, NP Assistant Professor Outpatient in the Physical Medicine and Rehabilitation department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Baclofen
Dose-Response Relationship, Drug
Humans
Injections, Spinal
Longitudinal Studies
Muscle Relaxants, Central
Muscle Spasticity
Practice Guidelines as Topic