Baclofen advice required

[Otter]

Before the Prescribing Guidelines came out, I couldn't figure out how Ameisen took baclofen so I carefully read his book again and sort of figured out that he was taking 270 mg a day in three doses. So, I tried to get my wife to take 90 mg at a time. This resulted in her not taking the drug at all because of the side effects.

Then I got in touch with a senior doctor who uses it in treatment and he explained that it had to be drip fed in small doses at regular intervals through the day and night to try to keep an even balance of it in the brain.

I read a lot of posts here of people having difficulty with the drug and they are usually just thinking that the total amount is the key rather than the regularity of the release of it in the brain.

If you consider baclofen to be a replacement for alcohol, by taking only a few large doses a day, its like taking large amounts of alcohol then having a massive hit from it, then letting it wear off. It's sort of like a roller coaster ride. What you want is a smooth ride. Divide the doses up as much as possible. Up it a little before bed and even take some in the middle of the night if you wake up. Since it wears off when you are asleep you need to take it as soon as you wake up as well. It's just one of those things. It is a tricky drug to take and I think a lot of people report failure but it's because they just don't understand the concept of taking it slowly and gently.

[neophyte]

Otter, I'm in the camp that says it doesnt matter how frequently you take it, but it has merit, afterall the halflife of baclofen is 1.5-4 hours
https://en.wikipedia.org/wiki/Baclofen

that said, i dose twice a day, side effect free, i can even skip days when i forget to take it. I've read on here of a member taking 1 dose a day.

not to sure whats going on, it would be interesting to get an explanation for this phenomenon. you cant take other drugs with half lifes like this without feeling nasty side effects think anti depresants like effexor (standard release) or benzodiazepines like xanax.

[knobert]

Hi Nic

I have a question for you. You said you don't know how to increase less than 0.5mg per dose and your taking 3 doses per day and your increases are 15 mgs. Did you mean 5mg per dose instead of 0.5mg per dose?

If you're aware of this, don't be mad at me, but I have to be sure. Your doses don't have to be the same. If you want to raise your daily amount by 5mg and you take 3 doses per day, you can just add it to one dose.

When Dr. Ameisen's bac level was at 230mgs/day, he took 50mgs in the morning, 90mgs in the afternoon and 90mgs in the evening because his cravings were non-existent or mild in the morning and worse in the afternoon and evening. He eventually reached indifference at 270mgs/day.

Also, don't forget you can change the frequency. When I was at 5 doses/day I took them at 6,10,2,6 and bedtime. That fit my schedule and also worked very well for easing my SEs.

Take care and keep it up.

Knobert :thumbsup:

[terryk]

From Clinical and Pharmacokinetic Aspects of High Dose Baclofen Therapy:

"Prior studies have assessed the pharmacokinetics of baclofen given in doses of less than 80 mg/day. They indicate the gastrointestinal absorption is rapid, peak plasma levels of 1 to 2 hours after ingestion and elimination half-life ranges from 2 to 6.8 hours. A small proportion of the drug is metabolized in the liver the major portion of the doses recovered in the urine in amounts ranging from 50 to 80%. Earlier studies of normal volunteers have found peak baclofen blood levels to occur between 1 and 2 hours after dose. In contrast, our data on five patients study throughout a dosing, demonstrates a peak level between 2 and 3.5 hours with later peaks occurring in those on higher doses."

and here's a source that says that the half-life is 6+ hours with chronic dosing:

A Controlled Pharmacokinetic Evaluation of Tizanidine and Baclofen at Steady State

"The mean elimination half-life of baclofen was 6.7 and 6.4 h when administered alone and in combination with tizanidine, respectively. The meanCLr for baclofen was 11% greater when tizanidine and baclofen were coadministered. None of the pharmacokinetic parameters between the treatment regimens reached the level of statistical significance."

While splitting a large daily dose into many small ones will most likely minimize side-effects (especially in sensitive individuals and those new to baclofen titration), baclofen's action as an anti-craving agent, in my opinion and experience, relies on an individual's daily threshold dose (with the caveat that everyone's body is different, and some people's kidneys may eliminate baclofen from the bloodstream at a slower or faster rate than others).

-tk

[terryk]

that said, i dose twice a day, side effect free, i can even skip days when i forget to take it. I've read on here of a member taking 1 dose a day.

not to sure whats going on, it would be interesting to get an explanation for this phenomenon. you cant take other drugs with half lifes like this without feeling nasty side effects think anti depresants like effexor (standard release) or benzodiazepines like xanax.

Baclofen withdrawal studies (where presentation of symptoms can take 24-72 hours) suggest that baclofen's action on GABA-b (either through down regulation of the receptor or the action of drug itself) is much longer lived than let's say the effect of alcohol or benzos at GABA-a (where presentation of withdrawal symptoms are usually 12-24 hours upon abrupt cessation).

-tk

[knobert]

Hey guys

that's all great and all but let's not lose track of danathos, lex and nicnak68

[nicnak68]

lol,thanks knobert
I will try taking Bac 4 times s day instead of 3

[Mom21961]

lol,thanks knobert
I will try taking Bac 4 times s day instead of 3

I'm going to try this as well. My SEs are many, and this last dosage increase has brought on nausea and muscle cramps. Not cool to be throwing up at work. Oddly enough, the somnolence is less at this dosage (225 mg in 3 equal doses).

[Mom21961]

I'm on 150mg a day and my daytime anxiety is ok but night time is pretty bad.I wake up for work at 4.30 am and I'm contracted 3 days a week but regularly do overtime and I keep waking up on my days off in a panic thinking I'm late for work and not remembering what day it is and if I'm working or not.

Nic... I posted about this on another thread, but I would highly recommend Calms Forte. I found out about it from Roberta Jewell's book. She recommended it for anxiety. It's an all natural herbal supplement. I get mine from Amazon. Just search for the name. As my alcohol use is decreasing, I've had trouble sleeping. A few calms forte and some melatonin fixed that right up. My husband (who doesn't drink) uses it for stress relief when feeling overwhelmed at work. It may be worth a try.

[knobert]

Hey Mom

I noticed that also about the somnolence. As I was escalating, the somnolence was very present. I mean sometimes my head would just hit my chest from one minute to the next. Then at a different level, it was less sudden and more manageable, only to re-occur again at another level.

That sounds terrible as its written, but the SE would usually diminish in 2 or 3 days and I would continue to escalate. If it didn't, I would stay at that level longer.

Sometimes, I would stay at a level for awhile even though my side effects had gone away just to take a break. Then after I had gotten my second wind, so to speak, or I had more free time, like days off, I would start to escalate again, ready to take it on.

A couple other things you might get a kick out of.
I always drank coffee. I love good coffee, freshly self ground Columbian supremo self brewed only the way I can make it. It was automatic every morning. I would drink work coffee when not at home. One day I realized I hadn't had coffee for a few days. I just hadn't thought about it, nor was I missing it. I checked my records, and I had forgot about coffee right about the time I went up to 140 mgs of bac. I still love coffee and have it if I want it, but I don't have to have it every morning or every day. In fact I hardly drink it at all anymore. I think that helped my anxiety some too.

Also, I hate to admit it, but I chewed Copenhagen. It's a filthy habit, I know. I chewed since I was 21 playing fast-pitch softball. Often, I would chew more than a round box a day. I wasn't trying to quit. I never thought about it. I was at 300 mgs/day and I thought why aren't I trying to stop chewing.
So I stopped chewing that day to see how it would go. I haven't chewed since. I missed the activity, something to do with my hands, for a while, but I had absolutely no cravings. LOL

Thanks Dr. A.

Keep goin' Mom
Catch you later

Knob :victorious:

[nicnak68]

Mom-is that like the calms they sell in the chemist?
The SEs this time round are much better but u still get a bit of daytime sleepiness and wake up a lot in the night but not as bad as the first time round.
I'm finding though that I'm very very tense round my shoulders and find they I'm hunched up and every time I think to I try to relax my shoulders but the next thing I'm tensed again

Knobert-I get the chin hitting the chest kind of thing but not as bad as last time and luckily not when I'm driving!
I don't drink coffee but I love my tea but not getting the same enjoyment out of it because it now doesn't taste the same.The same for wine really,although I'm still drinking I'm only drinking up to half of what I did before whereas last time I was drinking up to 3 bottles of wine a day and when I became indifferent the drinking stopped literally overnight.My tongue seems to have a white coating on it now which might be contributing to the taste thing and although I brush my tongue it never really goes away completely

[Mom21961]

Nic... Here is a link to the Calms Forte. It's cheaper though if you buy the 3 pack. Amazon.com : Calms Forte Hylands 100 Tabs : Medicinal Sleep Aids : Beauty

I also get the chin to chest thing. I just want to close my office door and curl up under my desk. Not a viable option though

Edit: Everything tastes odd to me as well. This sounds crazy, but even my teeth feel weird. This is relatively minor though compared to the shortness of breath, sleep apnea, and edema I've been struggling with. At least the insomnia has abated. Even the calms forte didn't cure that. I envy people with little or no side effects. If I wasn't so desperate to stop drinking, I would never willingly put myself through this!

[knobert]

Hey Nic and Mom

Just another bit of info regarding frequency of doses for baclofen.

The "Prescribing Guide for Baclofen" (for use by physicians) which has been around for quite some time now, proposes 4 doses per day in their own "proposed" dose scheme.
Also, this was their suggested proposal as their was no "standardized" way to prescribe.
They go on to say "You will frequently notice that there is no absolute concensus and that prescribers have different approaches and practices in the conduct of treatment. At the present time, it is impossible to give a definitive answer to the question.
This is their suggested proposal as their was nothing out there at the time.

Also, as far as the kidneys are concerned, if the amount of baclofen per day is split up into 3 doses or 23 doses, the kidneys still remove the same amount per day. In my opinion, if anything it may be beneficial as so much baclofen isn't being dumped on them all at once.

Take care

Knob :thumbsup:

[nicnak68]

I have started to take it 4 times a day so we'll see how it goes.
Mom,i have ordered the calms so hopefully that will help with the sleeping and shoulder tension.
I have had every SE reported and some,first time round I had a terrible cough that would have me coughing till my eyes watered,it was quite embarrassing.
I had unexplained bruising which I had a clotting test for but that was normal.And strange grazes that looked like scratches or as I called them,small lightning strikes

[Danathos]

I tend to get somnolence and perhaps a bit of weakness. I'm at about 150mg/day though I forgot my second dose today. I went to urgent care earlier (probably why I forgot my dose) because the anxiety is kicking my arse. They gave me Olanzapine and promethazine, though I could only get hold of the Olanzapine until Monday. Hard to tell if the Olanzapine is helping or not. took some an hour or so ago and I'm fairly calm now.

now I'm sober the Bac SEs are definitely a lot easier to deal with, I've just been questioning how much it is actually helping, especially regarding the anxiety and I feel uncomfortable with it not being endorsed by my doctors.

I don't have enough zopiclone(sleeping pills) for them to become a problem, I was only given 10 and I have 3 or 4 left, I've been tending to cut them in half.

Had a bad night last night, had a nasty anxiety attack whilst in bed, though managed to calm down eventually.

I refuse to drink again.