Dr. Levin's Titration Schedule

[Lo0p]

It's changed over the past year or so but from all the information I can gather he's pretty consistently been prescribing these (2 versions) to all his new patients for several months now:

First 3 days (or entire first week): 5 mg three times a day. For a total of 15 mg per day.

Next 4 days (or entire second week): 10 mg three times a day. For a total of 30 mg per day.

Every week thereafter he has you increase the total daily dosage 20 mg per day.

So in version 1, week 2 would be 50 mg per day

week 3: 70
week 4: 90
week 5: 110
week 6: 130
...
week 10: 210
...
week 15: 310
...
week 17: 350

Version 2 is the same thing only offset by one week.

Doses are to be taken evenly spread out in the morning, middle of the day and "a few hours before bed". The smallest dose (e.g. week 11, 230 mg would be: 80 mg, 70 mg and 80 mg) is to be taken in the middle of the day.

My a$$ this is a "side effect free" titration schedule. But he claims it is. The one patient of his that I referred to him in real life, reported to me that she had no negative side effects all the way up until indifference. But w/e.

I'm pretty damn sure that's it. I wouldn't be surprised if someone has recently been prescribed something different by him. His titration schedule has certainly evolved over time.

It seems like a kind of a pain in the butt to me for no other reason than this: each level requires you to split a pill in half.

[bobsd]

Dr. Levin's Titration Schedule

Hey Lo0p,

You are exact on Dr. L's current titration schedule... I am at 30 mg/day with no SE's, but I expect them along the way.

[Bill.P.]

Dr. Levin's Titration Schedule

Will all due respect to Dr. L.
I just spent 2 hours explaining to a patient of mine that I referred to Dr. L. Who happens to be a cardiologist patient (Im not supposed to know about "anything" but the heart)

ANyways, the titration level is a fucking joke, excuse my language. This guy if he had followed my titration level would be at 200mg/day.
Now, I rammed into his office and said WTF?
After 3 weeks you are JUST ramping up to 50mg a day and last weekend he got a dui and not to mention all sorts of other shit happening?

So I made up some shit on the spot about this guy names lOoP who went to 250mg in a weekend. Sorry LoOp if its not true.
But I am just getting pretty damn annoyed at stupid titrations. This lawyer couldve hit his switch in a weekend rather than lose his career.
Plus, anyhways, I had this huge talk about it today. So Im pissed

Im about to call Dr. Levin about this patient thats how pissed I am

[terryk]

Dr. Levin's Titration Schedule

Bill.P.;1192177 wrote: Will all due respect to Dr. L.
I just spent 2 hours explaining to a patient of mine that I referred to Dr. L. Who happens to be a cardiologist patient (Im not supposed to know about "anything" but the heart)

ANyways, the titration level is a fucking joke, excuse my language. This guy if he had followed my titration level would be at 200mg/day.
Now, I rammed into his office and said WTF?
After 3 weeks you are JUST ramping up to 50mg a day and last weekend he got a dui and not to mention all sorts of other shit happening?

So I made up some shit on the spot about this guy names lOoP who went to 250mg in a weekend. Sorry LoOp if its not true.
But I am just getting pretty damn annoyed at stupid titrations. This lawyer couldve hit his switch in a weekend rather than lose his career.
Plus, anyhways, I had this huge talk about it today. So Im pissed

Im about to call Dr. Levin about this patient thats how pissed I am

Huh?

[RudyB]

Dr. Levin's Titration Schedule

'Every week thereafter he has you increase the total daily dosage 20 mg per day.'

please pardon, that's the best i can do w quoting at the moment. but, loOp, i think you meant for that last word to say 'week,' right?

[Lo0p]

Dr. Levin's Titration Schedule

Bill.P.;1192177 wrote: Will all due respect to Dr. L.
I just spent 2 hours explaining to a patient of mine that I referred to Dr. L. Who happens to be a cardiologist patient (Im not supposed to know about "anything" but the heart)

ANyways, the titration level is a fucking joke, excuse my language. This guy if he had followed my titration level would be at 200mg/day.
Now, I rammed into his office and said WTF?
After 3 weeks you are JUST ramping up to 50mg a day and last weekend he got a dui and not to mention all sorts of other shit happening?

So I made up some shit on the spot about this guy names lOoP who went to 250mg in a weekend. Sorry LoOp if its not true.
But I am just getting pretty damn annoyed at stupid titrations. This lawyer couldve hit his switch in a weekend rather than lose his career.
Plus, anyhways, I had this huge talk about it today. So Im pissed

Im about to call Dr. Levin about this patient thats how pissed I am

Yes Bill, you are correct. I took 250 mg my 2nd and 3rd day, 150 mg on my first. It did save my life. However, my experience is contrasted by many, many others who could not tolerate that insane amount of baclofen so soon. Terryk, for one, did end up in the hospital titrating up much, much slower than I did. But it was too fast for them.

I agree that this is, has and will be an interesting topic of discussion but this thread was meant to be a resource for those people looking for a conservative titration schedule. Dr. Levin's schedule fits that. People ask for this all the time! Could please you move your post to a new topic so we can discuss it there?

[bobsd]

Dr. Levin's Titration Schedule

Really?? You are blaming Dr. L for causing this patient's DUI by him recommending a slow titration schedule??

[DrunkAndTiredInFLA]

Dr. Levin's Titration Schedule

Loop, I am not saying that you weren't told this titration schedule, but I was given a different one. Or perhaps, I came up with my own. lol I don't remember. Nevermind shutting up now. I will agree that he claims that you won't have any side effects. This was not the case for me. However, when I did have side effects, he told me to stay at that level until the side effects went away. That was helpful. =)

[DrunkAndTiredInFLA]

Dr. Levin's Titration Schedule

Bill.P.;1192177 wrote: Will all due respect to Dr. L.
I just spent 2 hours explaining to a patient of mine that I referred to Dr. L. Who happens to be a cardiologist patient (Im not supposed to know about "anything" but the heart)

ANyways, the titration level is a fucking joke, excuse my language. This guy if he had followed my titration level would be at 200mg/day.
Now, I rammed into his office and said WTF?
After 3 weeks you are JUST ramping up to 50mg a day and last weekend he got a dui and not to mention all sorts of other shit happening?

So I made up some shit on the spot about this guy names lOoP who went to 250mg in a weekend. Sorry LoOp if its not true.
But I am just getting pretty damn annoyed at stupid titrations. This lawyer couldve hit his switch in a weekend rather than lose his career.
Plus, anyhways, I had this huge talk about it today. So Im pissed

Im about to call Dr. Levin about this patient thats how pissed I am

Explain to me how if someone chooses to drive drunk, it becomes another persons fault??? lol And this ^^ is coming from a doctor.

[redhead77]

Dr. Levin's Titration Schedule

Bottom line: if you want your patients to follow a more aggressive titration schedule, prescribe it to them. Be prepared for the repercussions, if this is the case. We've read about a few people who've ended up in the hospital when doing rapid titrations. These people are doing this at home, and some don't have anyone looking after them.

That said, I will respect LoOp and not destroy his thread. Thanks for taking the time to bring it here LoOp.

[Otter]

Dr. Levin's Titration Schedule

Well done Bill

I have moved my original post here to the Dosage and Frequency Take 2 Thread

[redhead77]

Dr. Levin's Titration Schedule

Again, Otter, if Bill P is a physician and doesn't like how Dr L prescribes, maybe he should be prescribing it himself. He does know his patients. Dr L doesn't have to be one of the only cowboys out there.

EDIT: I'm sure there's the issue of colleagues finding out. How can one complain about something, and how someone prescribes, when they aren't doing it themselves? And all this is valid, but we do need to take it elsewhere.

[Otter]

Dr. Levin's Titration Schedule

redhead77;1192378 wrote: Again, Otter, if Bill P is a physician and doesn't like how Dr L prescribes, maybe he should be prescribing it himself. He does know his patients. Dr L doesn't have to be one of the only cowboys out there.

EDIT: I'm sure there's the issue of colleagues finding out. How can one complain about something, and how someone prescribes, when they aren't doing it themselves? And all this is valid, but we do need to take it elsewhere.

I suspect the answer to this is quite simple in that prescribing Baclofen is outside Bill P.'s area of expertise so his insurance would not respond to any claims against him. He may have his ideas which is why he is getting in touch with Dr. L but that does not necessarily mean he knows how Dr. L prescribes.

The problem as I see it for Dr. L is that Baclofen is, it seems to me, a highly individual thing. Dr. L appears to be putting everyone on a one size fits all schedule. The Glasgow study which is on the Baclofen UK site, has concluded that dosages need to be tailored. Thi s study is supported by senior practitioners including the editor of the International Journal of Alcohol and Alcoholism, Jonathan Chick who has a D.Sc.

I think Dr. L is courting disaster if he is just handing out a titration schedule over the phone and charging for it. Doctors are obliged to take full histories from patients to avoid them coming back and making claims about them. I just think someone should point this out to him. I don't think the body of medical knowledge is such that he could actually be sued for negligence for this but a time will come when that may be the result of this sort of prescribing.

[Ne/Neva Eva]

Dr. Levin's Titration Schedule

conjecture, conjecture, conjecture. And a reaction to Bill P's account of someone who was arrested for a DUI. That is ludicrous.

You have no idea, Otter, what Dr. Levin does or does not do. You have no idea how much he charges. He puts himself on the frontline, accepts calls at all times of day and night, and treats everyone he speaks with. He is one of the unsung heroes. What exactly is your issue with him?

A better titration schedule? Post it. Don't forget to back it up.

[hangingoninFL]

Dr. Levin's Titration Schedule

I recently called Dr L (to get a script) and he gave me the same titration schedule. I was already at 200 mg per day, with no SE and he told me to go back to 190 because 200 wasn't one of the "steps" in his titration schedule?? WTF??? I stayed at 200 and have since ramped up to 250 (I am adding 25 each week).

Regarding the spacing of the doses as prescribed by Dr. L, I actually switched from taking five equal doses during the day to three as he recommended, and found I suffered from way more somnolence so I have switched back to five.