Baclofen immunity

[whatismyname]

i have been on 30mg of baclofen (10mg 3x a day) for the last several years. my neuro agrees that it is time to up it. he just called in a prescription of 30 more mg a day. my question is this, does your body build up an immunity to baclofen? i'm wondering if i should start with taking 15mg 3 x a day rather than 20mg 3 x a day and see if that works. but if it doesn't make a difference in the long run to my body if i am taking 45mg a day or 60mg a day then i guess i will go with 60. understand??? thanks in advance.

[Redwings]

Do you mean, is it possible for a body to build up a tolerance to baclofen? Yes, in a way. It's also possible that the condition a person is taking baclofen for gets a bit worse over time, so a higher dose is need to manage the increase in symptoms.

Baclofen is one of those meds that can require adjustments over time. The usual maintenance dose range for oral baclofen is up to 80 mg per day in divided doses (usually 4). Starting your increase at 15 mg instead of going right to 20 is a good idea. The slower increase may not make a difference in the long run, but it will give your body a chance to make a less jarring adjustment, and help prevent some unpleasant surprises that could take hours to undo.

[lovejoy]

I'm not a doctor nor did i stay at the Holiday in express, when it comes to meds i would certainly talk to the prescribing doctor as to a message board, i would think the doctor has a reason ...... just saying

[whatismyname]

Do you mean, is it possible for a body to build up a tolerance to baclofen? Yes, in a way. It's also possible that the condition a person is taking baclofen for gets a bit worse over time, so a higher dose is need to manage the increase in symptoms.

yes, my spasticity is getting worse so i need to increase the dosage. i'm wondering if going to 20mg 3 x a day is the best solution if going to 15mg 3 x a day would do the same thing. does it even matter (15 or 20)? or is my body building up immunity to it and does it behoove me to increase as gradually as possible? i'm only 38 and have lots of time to go.

I'm not a doctor nor did i stay at the Holiday in express, when it comes to meds i would certainly talk to the prescribing doctor as to a message board, i would think the doctor has a reason ...... just saying

right-o. if asking him was an option i would do that. going through nurses and channels for a simple question is more than i care to fool with. besides, i learn ALL KINDS OF STUFF here that may or may not include my doctor.

[Redwings]

i'm wondering if going to 20mg 3 x a day is the best solution if going to 15mg 3 x a day would do the same thing. does it even matter (15 or 20)? or is my body building up immunity to it and does it behoove me to increase as gradually as possible? i'm only 38 and have lots of time to go.

One of the nice things about trying 15 mg first is that it gives you a controlled way of seeing if it might work adequately. If if doesn't, you can always add the other 5 mg to the next dose and see what happens. Much easier to add to the next dose than to go straight for the 20 mg and find out it was too much by spending 3 hours as an "overrelaxed" puddle of goo.

One of the principles of medication prescribing is to use enough to do the job and no more. So, in theory, if 15 mg 3x/day is adequate, there's no major rationale for moving to more. But, in knowing your history, your doctor felt that 20 mg 3x/day was indicated. So that's the objective you should keep in mind even if you decide to get there in a couple of increments instead of just one. The only way to know is to try it.

As an aside, I'm one who has always had to increase my immunosuppressant doses in a couple of steps because I can't take the sudden increase in side effects (even though my doctor prescribed a larger jump that most other people can handle). I've just learned to be cautious about the unpleasant possibilities of dosage increases, knowing I can always add more later. In the case of any medication that isn't life or death, I favor the cautions approach.

When I said that increasing slowly was a good idea, I was thinking of that end goal of 20 mg, and meant "slowly" to be over the course of a couple of days, maybe a week, just to make the transition less jarring and give you a little control over the side effects until your body adjusts. That's pretty short term.

If 15 mg instead of 20 does the job, it meets the guideline of not taking more med than you need. But in the long term, starting at 45 mg/day won't slow or prevent you from needing 60 mg/day if that's what your body needs. If you're thinking of "gradually" as increasing over the course of weeks or months -- hoping to prevent you from needing to go higher -- then no, how slow or fast you go up doesn't make any difference in the long run, the long run being months to years. It doesn't affect how quickly you might need more.

Speed only matters over the first few days or weeks, and that's for your comfort. Baclofen isn't one of those life-or-death drugs with a narrow effectivity profile that has to be managed by the milligram. If it were, your doctor wouldn't have doubled your daily dose in a single prescription. If you need to go up quickly to get relief, then you need to go up quickly. And again, starting slowly for a couple of days gives you a controlled way of finding that out with a minimum of surprises.

The converse of that is that going straight to 20 mg won't make you need more than 60 mg/day anytime soon, either. You managed on 30 mg/day for years. You might do very well on 60 mg/day for years to come. This is one of those things that can't be predicted -- the kind you can only do the best with that you can, with the information you have.

[Shashi]

I started out at 10 mg of baclofen once a day back five years ago. Over time, I had to increase to 80 mg a day, whether because of tolerance or worsening spasticity, I'm not sure.

A year ago, during a period of time when I wasn't having any symptoms, I managed to totally wean myself off of baclofen over the course of three to four weeks. (You can't go cold turkey off of it as it can cause hallucinations and other nasty side effects.) I was off of it for about three months, and then ended up having a flare up of symptoms in March/April and had to get back on it. I only went to 60 mg a day though.

I have been trying over the last few days to wean off of it again, but I don't think I'm going to be able to. I'm down to 40 mg a day for the past two days, but I'm having really painful spasms in my neck, hands, arms, legs (pretty much everywhere.) So, I guess I'll go back to my 60 mg dosage.

There are some here who take way over the maximum listed dosage. I'm not sure how they are managing that, but I hope I never have to do that and never have to get a pump either. Baclofen is the only thing that helps my spasms. Zanflex just knocks me out.

In my opinion, taking the least amount that you can while still getting results is the best way to go.