title: Best Practices for Intrathecal Baclofen Therapy: Dosing and Long-Term Management.
abstract: BACKGROUND
  Intrathecal baclofen (ITB) therapy aims to reduce spasticity and provide functional control.
  
  
  METHODS
  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.
authors.affiliation: Adult Neurology, OhioHealth Neurological Physicians, Columbus, OH, USA.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Boster
authors.affiliation: Adult Physical Medicine & Rehabilitation, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors.forename: Roy L
authors.initials: RL
authors.lastname: Adair
authors.affiliation: Adult and Pediatric Physical Medicine & Rehabilitation, Utah Neuro Rehabilitation, Salt Lake City, UT, USA.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Gooch
authors.affiliation: Adult Physical Medicine & Rehabilitation Nurse Practitioner, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Mary Elizabeth S
authors.initials: ME
authors.lastname: Nelson
authors.affiliation: Culicchia Neurological Clinic, New Orleans, LA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Toomer
authors.affiliation: Adult Physical Medicine & Rehabilitation, Physical Medicine & Neurotoxin Institute, Austin, TX, USA.
authors.forename: Joe
authors.initials: J
authors.lastname: Urquidez
authors.affiliation: Adult Physical Medicine & Rehabilitation, MossRehab, Elkins Park, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Saulino
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007278:Injections, Spinal / Q000379:methods* / Q000592:standards; D008137:Longitudinal Studies; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: Administration and dosage; baclofen; consensus; implantable; infusion pumps; intrathecal baclofen; muscle spasticity; patient care management