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Baclofen



- Discussion:
    - is the drug of choice for spasticity;
    - it potentiates the inhibitory effect of gamma-aminobutyric acid on reflex arcs;
    - adult dosing:
           - typical regimen begins with a dose of 5 mg given orally twice a day, which is increased to the minimal effective dose;
           - reasonable maximal daily dose in a young person is 200 mg (though this exceeds the maximal dose recommended in the package insert).
    - peds dosing:
           - between ages 2-7 yrs old: give 3-5 mg PO tid;
           - dose can be titrated upward in 5 mg increments, q 3days;
           - maximum dose 40 mg per day in order to obtain the desired effect;
           - children greater than 8 years of age max dose is 60 mg per day;
    - cautions:
           - sedation is a common early side effect that may abate; delirium and seizures are rare;
           - abrupt cessation of baclofen can cause dramatic withdrawal syndrome (or seizures), and patients should be cautioned about this;
           - occasionally, a patient is hospitalized because of an unrelated problem, and the baclofen is discontinued, which precipitates
                   withdrawal symptoms and needless investigation



Intrathecal Baclofen For Severe Spinal Spasticity.