Intrathecal
Baclofen Therapy Dosage Adjustment Assessment:
- Goal
Setting - have they been met by current dose
- Degree
of muscle tone
- Severity
and frequency of spasms
- Presence
of adverse drug effects
- Patient-related
conditions
- Functional
assessment
- Systems
functions
- Educate
Maintenance
of Effective Treatment
- Some
dosage adjustment is typically required over time to maintain
the clinical response. Typically this adjustment period requires
patience and often does not exceed 6 - 12 months. This experience
varies from series to series, and obviously person to person.
(correct - jc)
(graph
shows baclofen dose adjustment over time in patients using itb
for severe spasticity)
Graph
of Lioresal Intrathecal Maintenance Dosage Profile: dose adjustment
over time in months after pump implant. (This graph - from Intrathecal
baclofen for spasticity of spinal origin: seven years of experience;
R.D. Penn, J Neurosurg 77:236-240, 1992 )
- To
maintian effective treatment in this series, the baclofen dosage
was increased gradually over the first 2 years, after which the
requirement tended to stabilize.
- Lioresal
is primarily excreted unchanged by the kidneys, it should be
given with caution in patients with impaired renal function and
it may be necessary to reduce the dosage.
- No
specific laboratory tests are deemed essential for the management
of patients on Lioresal Intrathecal.
Evolution
of average baclofen dosages during follow-up (Intrathecal Baclofen
Administration for Control of Severe Spinal Spasticity: Functional
Improvement and Long-Term Follow-Up. Azouvi P, etal., Arch Phys
Med Rehabil Vol 77, January 1996 35-39)
- "Average
initial dose of intrathecal baclofen after pump implantation
was 142.8 +/- 90.9ug (range: 20 - 425ug). During the first 6
months after implantation, dosage was progressively increased
for 14 patients (77%) to maintain treatment efficacy. Average
dosage at 6 month follow-up was 312.1 +/- 189.9ug. The difference
between initial and 6 moonth dosage was statistically significant.
Mean dosage mooderately increased from 6 to 12 months (12 month
dosage: 339+/- 187.5ug), but the difference was not statistically
significant. No dosage increase was observed after 12 months."
- When
patients were compared according to the nature of the spinal
lesion (traumatic vs nontrumatic), if traumatic - according to
the level (cervical vs thoracic), and the severity of the lesion
(complete vs incomplete); the comparisons of drug dosage as well
as dosage change over time found no significant difference.
- Patients
with Multiple Sclerosis showed a greater variabillity in dosage
than those with Spinal Cord Injury, which was probably a reflection
of the fluctuations found in the course of MS (from Chronic intrathecal delivery
of baclofen by a programmable pump for the treatment of severe
spasticity, OrdiaJ, J Neurosurg 85:452-457, 1996).
