Baclofen Withdrawal: What You Should Know About Symptoms, Time Frame, and How to Safely Taper Off

What you will learn

• Definition: Baclofen withdrawal happens when a person abruptly stops taking baclofen or decreases the dose significantly, causing symptoms to appear.
• Symptom Intensity: The intensity of the withdrawal symptoms will depend on the individual's prior experience with using baclofen and how much was used.
• Route Risks: Use of intrathecal baclofen provides a greater risk of withdrawal than oral use, and if there is a failure of an implanted pump, withdrawal symptoms can escalate very quickly.
• Timeline Factors: The timeline of baclofen withdrawal will vary greatly depending on the amount of baclofen used, how long the individual has taken baclofen, and how well they taper off.
• Professional Support: Medical professionals will be able to advise on the best way to taper off baclofen and provide support through detoxification and long-term recovery.

Stopping a medication can feel overwhelming, especially when you are unsure what your body may experience next. Baclofen (available in oral tablets and solutions or intrathecal routes under the brand names Lioresal, Gablofen, and Ozobax) withdrawal refers to the physical and psychological symptoms that can occur when baclofen is reduced too quickly or stopped suddenly. For some people, symptoms are uncomfortable but manageable with medical support. For others, especially those using intrathecal baclofen, withdrawal can be serious and requires urgent care [1].

If you have made a medication change as part of your recovery journey, being knowledgeable about the changes occurring within your body can be a powerful tool for providing peace of mind. This guide is designed to explain what baclofen withdrawal is, what symptoms to watch for, how long it may last, and how taper safety plays an essential role in protecting your health.[2]

What is Baclofen, and Why Does Baclofen Cause Withdrawal?

What baclofen does in the body

Baclofen is a central nervous system (CNS) depressant that is used to reduce muscle spasms associated with conditions like multiple sclerosis, cerebral palsy, and spinal cord injuries. Additionally, some healthcare providers prescribe baclofen as an off-label treatment for alcohol use disorder or alcohol withdrawal.[3] Baclofen reduces the amount of nerve impulses sent to the brain when someone suffers from a muscle spasm.

Why stopping suddenly can cause withdrawal

Over time, the body builds a tolerance to baclofen, and when baclofen levels decrease quickly, the central nervous system (CNS) becomes overstimulated. The CNS overreacts to the rapid decline in baclofen levels.[4] Withdrawal from baclofen can from the discontinuation of baclofen before the body has returned to normal nerve activity.

Oral vs. intrathecal baclofen: the withdrawal risk is not the same

There are two ways of administering baclofen, orally or intrathecally (directly into the spinal fluid via a surgically implanted pump). The withdrawal risks for both methods are similar, but differ greatly in severity as follows:[5]

Physical Reactions that Occur During Baclofen Withdrawal

During baclofen withdrawal, the CNS reacts to the absence of baclofen.[4] The nervous system may become overactive, and people can experience increased muscle tension, restlessness, anxiety, and changes in sleep. Cognitive symptoms—meaning those related to thinking—may include confusion or difficulty concentrating. These effects reflect the body adjusting to the sudden change in medication levels.[5]

Using intrathecal baclofen will produce withdrawal symptoms much more quickly and in a much more severe manner than oral baclofen. Because it is delivered directly into the spinal fluid, when there is a malfunction of an implanted pump or blockage of a catheter, the likelihood of severe withdrawal symptoms occurring is very high. In severe cases, the body may experience high fever, altered mental status, and muscle rigidity.

Common Symptoms of Baclofen Withdrawal

Though baclofen withdrawal symptoms differ in each individual, the most frequently reported symptoms are: muscle spasms, tremors, nausea, heart palpitations, increased anxiety, agitation, sleep disturbance, and cognitive impairment.

Severe symptoms: medical emergency

Due to severe withdrawal symptoms from intrathecal baclofen therapy, it is crucial to seek urgent medical attention if the following occur:[4]

• Fever
• Altered mental state or confusion
• Seizures
• Increasing severity of muscle spasticity or rigidity
• Respiratory distress: impaired breathing that can be life-threatening, where the body cannot obtain adequate oxygen.[5]

Early warning signs specific to intrathecal therapy

You must be vigilant for early warning signs of intrathecal therapy withdrawal.[6] Common signs of intrathecal baclofen withdrawal include sudden onset or increase in spasticity, itchiness, dizziness or lightheadedness, tingling or numbness in the extremities, and low blood pressure. Identifying these signs and acting quickly can save a life.

What is the Duration for Baclofen Withdrawal?

Baclofen withdrawal may start to manifest as early as hours after discontinuation of the medication, with some individuals experiencing peak symptoms within the first few days.[4] Many individuals will begin to feel much better within a few days of proper tapering or stabilization, while others will continue to experience lingering effects such as anxiety or difficulty sleeping for weeks after stopping baclofen.[5]

Several factors contribute to the duration of baclofen withdrawal:

• Dosage level and length of use
• The type of administration (oral or intrathecal)
• The rate of tapering
• Individual medical conditions or other medications

Guidelines for the Safe Tapering of Baclofen

Taper safety is one of the most important elements of preventing severe withdrawal effects. A customized tapering regimen [2] must be developed and guided by a prescribing clinician.

General tapering principles

Monitoring: Tapering should include regular monitoring and documentation of symptoms.

Speed: Tapering must occur slowly and carefully.

Adjustments: If an increase in withdrawal symptoms occurs at any time during tapering, the tapering should be adjusted (slowed or interrupted) accordingly.[2]

Supervision: It is important to maintain close contact and supervision with a physician if a patient is on higher doses, long-term therapy, or intrathecal baclofen.[2]

Tapering checklist for patients

Conversations with a healthcare provider should include:

• When should symptoms be reported?
• How fast should doses be reduced?
• How will sleep, anxiety, and muscle spasticity be managed during the taper?
• What happens if a dose is missed?
• Does the provider have procedures to follow for pump alarms and emergency contacts?

Overall, patients should avoid trying to alter their dose without the guidance of their physician.

Medical Evaluation and Treatment

Medical evaluation of baclofen withdrawal should include an assessment of the patient’s vital signs, level of hydration, and overall neurologic function. For intrathecal withdrawal, checking the pump’s function is vital.[4]

Treatment options typically consist of safely restoring baclofen levels and‌ providing supportive care [3]. In severe cases, clinicians may utilize medication to manage agitation and seizures while they address the underlying cause of these symptoms. Levels of care range from outpatient monitoring to intensive hospital management, depending on the severity of the symptoms.[5]

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more