Baclofen Withdrawal Symptoms and Treatment

Why baclofen withdrawal occur

Baclofen is a gamma-aminobutyric acid (GABA) agonist that is used to treat spasticity, muscle spasms, pain, and rigidity in the context of various conditions, such as spinal cord lesions and multiple sclerosis. ^[1]

Baclofen is a GABA-B receptor agonist, which means that it reduces the release of certain neurotransmitters and inhibits postsynaptic neurons. These actions help to decrease spasticity and reduce central nervous system (CNS) activity, creating sedating and relaxing effects on the body. ^[1][2]

After some time, the body becomes dependent on the medication and adapts to the physiological changes it produces. When the medication is stopped, the body is suddenly required to function without the effects of the drug. Because baclofen impacts GABA receptors and the nervous system, withdrawal from the medication can cause symptoms related to these systems. ^[3]

Baclofen withdrawal symptoms

Risks of abrupt baclofen discontinuation

A gradual decrease of baclofen may cause some mild withdrawal symptoms that typically can be managed. However, if someone suddenly stops their baclofen treatment, especially after a long-term or high-dose treatment, the risk and severity of withdrawal increase. ^[3]

In some cases, withdrawal symptoms after abrupt discontinuation may be mild initially, gradually increasing in severity, particularly if left untreated. Also, there are different forms of baclofen, including oral tablets and liquids, transdermal patches, and intrathecal pumps, which can result in varying severities of withdrawal symptoms. ^[3][4]

Intrathecal baclofen (ITB) administers baclofen directly into the spinal cord. Withdrawal from abrupt cessation of ITB can be particularly severe and will require immediate medical treatment to prevent severe or life-threatening consequences. ^[3]

Baclofen withdrawal timeline: How long does baclofen withdrawal last?

The progression of baclofen withdrawal can vary depending on the administration method and whether medical intervention is implemented quickly. Generally, withdrawal symptoms will emerge within hours or days of the missed dose. ^[3]

Oral baclofen withdrawal often emerges as mild to moderate symptoms, which can progress and worsen if not treated. With appropriate treatment, symptoms can be managed, and progression can be prevented. ^[3]

ITB withdrawal can occur due to equipment malfunction and will often emerge with sudden, severe symptoms. Initial withdrawal symptoms can include rebound spasticity and fever. These symptoms can progress quickly without treatment, and more severe symptoms (such as hallucinations, delirium, and seizures) begin. Left untreated, ITB withdrawal can result in rhabdomyolysis, profound autonomic instability, severe heart issues, organ failure, and death, within a matter of days. ^[5]

As such, treatment should be implemented urgently to manage the presenting symptoms while also reinstating baclofen doses. 

One case study describes a young boy treated with ITB, who developed withdrawal symptoms within 5 days of ITB removal. This required medical care within an ICU, with significant improvements taking 19 days, followed by a discharge at 46 days with follow-up care in the community. ^[5]

Baclofen withdrawal management and safe tapering

Managing baclofen withdrawal can depend on the circumstances. In most cases, it is necessary to restart baclofen to reduce withdrawal symptoms and prevent severe progression. Alongside this, specific symptoms will need to be managed. ^[3][4]

Patients should be monitored, checking vital signs, cardiac functioning, and adequate hydration. Should these signs become problematic, treatments can be initiated, such as intravenous fluids. It may be necessary for the individual to be admitted to the ICU, where they can be closely monitored until their health has stabilized, in order to manage urgent changes or signs of life-threatening conditions. ^[3][5]

Medications can be administered to manage withdrawal symptoms. For example, benzodiazepines may be utilized to reduce the risk of seizures and agitation. Propofol, a potent GABA-A receptor agonist, can help prevent the progression of baclofen withdrawal symptoms. ^[3]

Once stabilized, a safe tapering schedule can be initiated if it is deemed appropriate and necessary to discontinue baclofen. This might include a gradual dose reduction over two or more weeks, which can be slowed or paused to prevent severe withdrawal.

Can baclofen withdrawal be managed at home?

If baclofen is discontinued with gradual dose reductions, withdrawal symptoms may be less likely or less severe. In these cases, it may be possible to manage at home. However, many cases of baclofen withdrawal require professional intervention, particularly if the medication is stopped abruptly. 

As such, it is necessary to seek professional guidance and monitoring when discontinuing baclofen, to ensure dangerous symptoms are recognized and treated urgently if they occur. ^[1]

Long-term recovery after baclofen dependence

People who have used baclofen should be provided with appropriate medical care to ensure that their symptoms are managed effectively, and they may be prescribed alternative medications after discontinuing baclofen. Additionally, any long-term effects of baclofen withdrawal will continue to be monitored and treated.

Some people may misuse or abuse baclofen due to its sedating effects, such as using it alongside other substances. In these cases, it may be necessary to utilize specialist substance use disorder treatments to manage withdrawal and address addictive or substance use behaviors. 

Long-term recovery can include therapies to help cope with emotional distress and factors that contribute to substance misuse, along with support groups, such as Narcotics Anonymous, in which individuals can share experiences and support one another in their recovery processes.