Baclofen Titration Thread

[tiptronic_ct]

At the insistence of Beatle (:l ), herewith a Baclofen titration thread, where we can post about our own experiences.

As a start, let's look at Dr. Ameisen's original approach, as published in his self-case report.

On January 9, 2004, day 1 of post-relapse abstinence,
I started oral baclofen monotherapy: 10 mg three times daily
(30 mg/day), adding 20 mg/day every third day; optional
20–40 mg/day p.r.n. at a time was available for cravings or
important inter-current stress or anxiety. Since cravings
appeared during afternoons or evenings, dosages were divided
unequally: lower in mornings, i.e. on day 31 (230 mg/day)
I took 50 mg, then 90 mg, then 90 mg.

IMO, this represents a cautious yet systematic approach.

Since joining MWO and participating on the meds threads, I've witnessed lots of debate and we've seen different approaches put into practice. Through sharing your own experience, we might see patterns emerging and maybe provide guidance to others who are unsure but can learn from people in similar situations.

What works / worked for you? If doing this under medical supervision, what did your doc recommend and how did you find the results?

I'll provide info about my own experience and titration schedule in a subsequent post.

[Lo0p]

Baclofen Titration Thread



I'll fill the rest in in the morning.

edit: Soon I promise... :argh:

[tiptronic_ct]

Baclofen Titration Thread

When my bac arrived, I started out using the suggested titration schedule posted by Zenstyle in this thread: https://www.mywayout.org/community/f2...ion-34919.html

It is:

(15mg) 3 x 5mg daily for 3 days.

(30mg) 3 x 10mg daily for the next 3 days.

Then add on 10mg daily and stay with that for 3-5 days before progressing to the next amount, depending on how it reacts with your system.

However, I soon found out that at lower doses, I had very few if any SEs. I upped my rate of titration to 10mg a day. From 180mg upward, experiencing severe SEs (nightime insomnia and daytime somnolence), I kept my dose at the same level during the week and would titrate up by 20mg - 30mg on a Friday afternoon. That way, I had some time to adjust to the higher dose by the time Monday came round.

Intitially, I stuck to equally divided doses, but started adding more to my afternoon and evening doses, in line with Dr. A's scehdule. I eventually settled on 4 daily doses, the last one no later than 7.00 p.m.

On Friday the 21st of August 2009, at approximately 9.10 p.m, having upped my dose to 270mg per day hours before, it dawned on me that I had reached the point of indifference. The rest, as they say, is history

I stayed at that dose for two weeks, at which point the daytime somnolence was so bad that I caused an accident in rush-hour traffic. I started tapering down at a cautious rate of 10mg every 3 - 4 days.

[bleep]

Baclofen Titration Thread

Good thread Tip.

My views on dosage are pretty well known, but this is a good place to reiterate them.

My dosage schedule was, um, rapid. I went for the first 3 days at 15mg's, in the now traditional 3 x 5 approach. I then doubled to 30 for a couple of days, then, due to no side effects, I just went up and up, ending on 400mg's+ after 3 and a half weeks.

I would not recommend this approach.

The approach I would recommend is this:

Start of with 3 x 5mg's for a couple of days, then go to 3 x 10. From this point on, you listen to your body. If your body is saying it's ok, increase by 20 mg's , then wait a few days. Rinse and repeat. Don't have a period where you just go up and up, give the baclofen time to soak into your brain. Although you may feel fine on the SE front, baclofen is working its tricks with your mind. You can't always feel this, but it's happening, so DON'T just ramp up your dose. Spend a few days at least on various levels.

Continue in this fashion until you reach indifference. If bad SE's occur, try sticking at your at your dose for a few days, and see if they reduce. If they don't, I found that baclofen SE's are extremely dose dependent, so sometimes it helps to actually increase your dose if you are having bad SE's. This is very counterintuitive, but seems to work in a lot of cases. The effect on your mind takes 4 or 5 days to filter through, so consider that when trying to push back through a level that is giving you difficulty.

How you take your baclofen is as important as how much you take. Despite taking 450mg's per day, I never took more than 30mg's in one hit, except for a couple of occasions where I took 40mg's, and felt like I had been hit by a truck. If you are on, for example, 100mg's then work out how many dosing times you have in a day and divide your dosage by that. So if you work out you will take pills every 2 hours for the 16 hours you are awake, you take 12,5mg's, or whatever is reasonable, per dose.

Good luck, with whatever titration schedule you choose!

[Ne/Neva Eva]

Baclofen Titration Thread

Excellent, tip.
I would humbly suggest that we use a format or formula. I found that it was helpful when people listed it like this:

x milligrams/day for x number of days taken in this interval
x mgs/day for this many days at this interval
and etc...

That way newbies and statisticians don't have to suss out each person's individual titration.

I personally am in favor of Dr. OA's titration versus some of the other schedules that have recently been posted. In my very humble opinion staying at one dose for a week or longer when experiencing side effects that are onerous is the opposite of what worked for me. I found that with each bump up the side effects lessened and my consumption and need for alcohol was often (but not always) decreased.
Also, no need for apologies, imo. If something landed you in the hospital or you freaked out, it would be very helpful to have an understanding of why you think that happened (other medicines, supplements, comorbidity, etc..) Otherwise, if it worked for you and you reached indifference then lay it all out! Right? Even the ones that seem fool-hardy and take a body/mind of steel and some serious time off of work have a place here. (lo0p! spell it out.)

[tiptronic_ct]

Baclofen Titration Thread

Ne/Neva Eva;1065278 wrote: Excellent, tip.
I would humbly suggest that we use a format or formula. I found that it was helpful when people listed it like this:

x milligrams/day for x number of days taken in this interval
x mgs/day for this many days at this interval
and etc...

That way newbies and statisticians don't have to suss out each person's individual titration.

Good suggestion. I would have set it out like that, had I kept a detailed log. Hopefully people will do it from the outset, since it is valuable to others after the fact. To try and reconstruct my detailed titration so long after it happened is impossible. Time (and memory) flies, huh?

[PbarE]

Baclofen Titration Thread

Thank you for this great thread.

I found an addictionologist who is willing to prescribe and monitor my progress. He was already prescribing baclofen for cravings, but at much lower levels. He was very intrigued by this, so I gave him a copy of Dr. A's book along with the phone numbers of other docs who use the high dose therapy.

His biggest concern was the titration schedule. He asked me to do some research on this, and lo and behold, ya'll have already done it for me.

Right now I am at 180 mgs, and experiencing the same SE's Tip mentions (insomnia at night, nodding off in the day).

I have been using this schedule;

7 am - 40 mg
11 am - 40 mg
3 pm - 50 mg
7 pm - 50 mg

After reading bleep's post, I am thinking of changing that up. His statement, "How you take your baclofen is as important as how much you take" really rings true. I am assuming there is no "one size fits all" approach to this.

[Murphyx]

Baclofen Titration Thread

Day 1, 25mg, 4 evenly spaced doses
Day 2 as above
Day 3 50mg, 5 evenly spaced doses
Day 4 as above
Day 5 80mg, 8 evenly spaced doses
Day 6 as above
Day 7 120mg, 8 evenly spaced doses
Day 8 150mg, 8 evenly spaced doses (the switch!)
Day 9 as above
Day 10 on = 150mg in six doses: 8am, 10, 12, 2pm, 4, 6. Making 6pm my last dose to stop me falling asleep too early and allowing a (relatively) normal night?s sleep.

It happened very quickly; eight days from start to switch. But if I was doing it all over, I would slow it down, maybe increase by 25 every 2 or 3 days. The reason being that I was quite seriously messed up around days 7,8 and 9; I could barely remember how to speak, a 2 sentence email took 30 minutes to write, I was getting severe electric shocks from elbow to fingers, I think my BP went through the roof (I don't know for sure because I was too whacked out to operate the BP monitor) and I was dizzy as hell and on the verge of falling over most of the time. Basically I hadn't given my brain time to catch up with the dose and it all hit me at once to the extent that I thought I may have given myself brain damage. But I haven't...probably...I may be too brain damaged to be certain though.

If you went up 25mg every 3 days then you would hit (what I think is probably the average) switch point (250mg) at 1 month. But in order to do this you need to be able to push on through the side effects. This won't be possible for everyone. But if you can take time off work (or have control of your work hours/days) and have the determination to succeed you should be able to. But of course if it seriously affects your health (dangerously high BP), or you are a lone parent with caring duties, or you can't control your work pattern and need to operate machinery or drive (or just not seem stoned in the office), then this won't work.

It also won't work if you don't want it to. I know that sounds crazy but you have to want this to happen. You have to be prepared to push through the side effects (bearing in mind the exceptions listed above) because you really do want to knock the drink on the head and stop using it as a crutch or an excuse. Maybe that should be listed as another exception i.e. psychological resistance.

I went too fast, but some people go too slowly. Some people spend many, many months titrating up incredibly slowly. Either because they're religiously sticking to a prescribed regime provided by someone they consider a god, or because they can't cope with the thought of the side effects getting worse. As has already been mentioned in this thread the side effects may not get worse, they may improve and you may get new ones (maybe nice ones). One thing's for sure though, if you think like that, it's going to take a helluva long time to reach the switch and there's so much more chance that you'll just get so fed up with the whole thing you'll end up dropping the baclofen.

Here endeth the gospel according to Murph.

It may just be the ramblings of a brain damaged ex-alcoholic, but please note the "EX".

[Longshot]

Baclofen Titration Thread

I'm currently on 425mg Bach and have been for about 3 weeks.

No sign of a switch. I drank on 400mg.

[Lo0p]

Baclofen Titration Thread

Longshot;1065364 wrote: I'm currently on 425mg Bach and have been for about 3 weeks.

No sign of a switch. I drank on 400mg.

This isn't really the thread for that friend! You should delete this post. But before you do, be sure to repost it in a new thread of your own so we can sort this out!

In order to delete it, you have to go in and edit it...then somewhere in there is an option to delete the post.

You do that and I'll try to remember the name of the guy who hit his switch in the stratospheric range (400+). Maybe we can find him and get you two in contact.

Deal?

[Longshot]

Baclofen Titration Thread

Lo0p;1065400 wrote: This isn't really the thread for that friend! You should delete this post. But before you do, be sure to repost it in a new thread of your own so we can sort this out!

In order to delete it, you have to go in and edit it...then somewhere in there is an option to delete the post.

You do that and I'll try to remember the name of the guy who hit his switch in the stratospheric range (400+). Maybe we can find him and get you two in contact.

Deal?

Done, now remove your quoting of my deleted post and the Minister of Truth will have had a good day.

Double Plus Good!

[Ne/Neva Eva]

Baclofen Titration Thread

This is the beginning:

I started taking baclofen this time around on Oct. 6th.
Titration as follows:
5mg/day for 3 days
10mg/day for 4 days in two doses
20-30mg/day For about 5 weeks. Records spotty, but SEs sucked.
90mg/day Not sure, but if that’s the case, what was I thinking?
70/day
50mg/day
60mg/day for 3 days
100mg/day for 4 days
120mg/day for 6 days
140mg/day for 5 days
120mg/day for 4 days
2nd day at 140mg/day (as of 12/12)

I highly recommend taking bac every 3 hours. I only tried waking to take bac a couple of nights and soon realized that the sleep disruption was more debilitating than the 'benefit' of constant bac in my blood. I definitely don't recommend waking. (hmmm. just realized, I do set an alarm for 11pm and wake to take one then. I wake between 4am and 5am, so the downtime is less than 6 hours, often.)

I followed the titration schedule of adding 20mg/week after this, more or less.
It was MUCH TOO SLOW. There is always room to go back down for a couple of days, and I wish I had employed that earlier in my journey.

I always went up on a Friday, because I found that going up was often uncomfortable. Sometimes I stayed at a higher dose for Fri, Sat and Sun and then went down by 10mg or 20mg on Monday to start the work week. That worked very well.

Found indifference on February 4, 2011 (! ) at approximately 340mg/day. But at that point, it was very hard to keep track of what I was taking or even if I'd taken it, despite my elaborately simple system for dosing. Which is vital. Imperative even, once you get past a certain dosage.

:goodjob: tip. Thanks
Ne

[Ne/Neva Eva]

Baclofen Titration Thread

Titration, or how to take bac, and how not to take bac, will ALWAYS be hotly debated. Even after there is a definitive protocol in place, I'm sure.

No-one, I repeat, NOT ONE PERSON on this forum has any expertise or can reccomend one protocol over another with any medical knowledge, save Dr. OA. That's it.

Here's a good rule of thumb:
Don't take too much.
Don't take so little that you won't reach the goal.
DON'T RUN OUT if you are taking it for an extended period of time, and taking a lot of it.

If you are new, or are considering taking bac, treat this thread as what it is: A lively debate among people who have strong opinions. People who ONLY WANT to help others find a path so that they can achieve the goal. That's it. The rest is kerfuffle.

To the rest of us, let's carry on with the debate in that spirit, huh? I apologize for contributing opinions around here about this as though they were solid. They're not. The debate rages on even now in my own mind.
One other thing I am sure of: If you don't keep taking the pills you will not find indifference. Managing that is up to you.
:h
Karen/Ne

[beatle]

Baclofen Titration Thread

Amazing thread:yay:

Even more amazing posts. THANK YOU!

[bleep]

Baclofen Titration Thread

Ne/Neva Eva;1066183 wrote: Titration, or how to take bac, and how not to take bac, will ALWAYS be hotly debated. Even after there is a definitive protocol in place, I'm sure.

No-one, I repeat, NOT ONE PERSON on this forum has any expertise or can reccomend one protocol over another with any medical knowledge, save Dr. OA. That's it.

Here's a good rule of thumb:
Don't take too much.
Don't take so little that you won't reach the goal.
DON'T RUN OUT if you are taking it for an extended period of time, and taking a lot of it.

If you are new, or are considering taking bac, treat this thread as what it is: A lively debate among people who have strong opinions. People who ONLY WANT to help others find a path so that they can achieve the goal. That's it. The rest is kerfuffle.

To the rest of us, let's carry on with the debate in that spirit, huh? I apologize for contributing opinions around here about this as though they were solid. They're not. The debate rages on even now in my own mind.
One other thing I am sure of: If you don't keep taking the pills you will not find indifference. Managing that is up to you.
:h
Karen/Ne

Great post.