Baclofen - question about finding your maintenance dose

[neophyte]

I switched at 300mg of baclofen and stayed at that dose for a long time, i decided to try and reduce the dose slowly, nearly over 6 months, I wanted to see how each 25mg reduction would impact me and re evaluate. I was hoping I could go really low, like 100mg and just sit there...

Recently i dropped from 225mg to 200mg and suddenly those old cravings come back. I gave in yesterday when my partner brought back some wine and had a drink, I didnt stop until last night i finished off 1 and 1/4 bottle of wine, I havent drank that much in nearly 2 years. I was receiving euphoria from the alcohol, nothing like the days of no baclofen but there was a tingle i was chasing. compare this to 300mg of baclofen and alcohol just makes me feel crap. This amount of drinking is much lower than pre bac days 2 bottles of wine and sometimes more. but scared me none the less and im going to go back up in baclofen.

I have a question, I had no issues at 225mg of baclofen. For those of you have found yourself in this situation, can i just go back up to 225mg and expect the same anti craving effect or do I need to go higher than back down to 225mg. I really don't want to go up to 300mg again. I read in the 2 year study this was recommended but I was looking for personal experiences.

Interestingly this experiment has confirmed that maintenance doses are around 2/3 of switch doses. So if anything, i hope my self experiment helps others considering the same thing.

[Ne/Neva Eva]

Neo, I've jumped around all over the place, so I can't speak directly from experience. I switched at 325, went up and down and landed around 220, then went down to 80 and stayed there for many months before my drinking got out of control again.

If I were in your shoes, I would go higher than 225, maybe 250 or 275 and then come back down again. I say that because I would want to know with absolute certainty that I wouldn't start craving again. I've been in this position for almost 10 months and the next time, I won't even pretend to lower my dose for a loooong time. Especially not to craving.

Hope you're not too hungover!

[neophyte]

Thanks Neva, im only a bit hung over and regretting having those extra drinks, sometimes ill have a glass or two of wine with my SO which doesnt really do anything for me.

This time was different, i started on the rest of the bottle and then 1/4 more. i was chasing a small buzz but it really wasnt going anywhere and i stopped myself. I think with will power i wont do it again, but that hasnt happened to me in a long time.

That feeling that once you start drinking you cant stop, thats something i havent experienced in a long time.

whats interesting also is that i havent worken up in a complete anxious wreck like i would have before on even 1/2 a bottle of wine. I suspect that if i were to continue drinking this "normal hangover" will revert straight back to crippling anxiety. Though it suggests my brain has recovered somewhat, it took months to get there, so i won't throw it away.

[knobert]

Hi Neo

From what I've seen from other stories I have read, they often have to go up higher for a while, then can come back down to their maintenance dose.
Here's an oldie but goodie:

My maintanance dose is 100mg.

As far as relapsing, I still occasionally drink socially, which hasn't generally been a problem for me. One time, however, I had more than I should have (it was only about 4-5 drinks, but since I haven't been drinking much since hitting my switch, it made me feel pretty drunk). I didn't drink that amount because I felt a craving for it - it was more a kind of peer pressure thing, with everyone buying rounds for each other, etc. After that day, I had to up my daily dose to 120-130mg for a few days, since I started feeling some cravings creeping back. I didn't continue to drink, though, and after a few days I went back down to 100mg. But it indicated to me that relapse might be a possibility. It was easy to defeat the momentary craving with a little extra baclofen, though, so it didn't strike me as a very big concern.

Here's some info from Dr. A's book. (Bottom of page 191 and top of page 192, his second challenge).

He was at his maintenance dose of 120. He had 5 drinks in 6 hours. He had cravings return. He increased his dose until he got to 180, which killed the cravings, then was able to step down getting back to 120mgs.
Check it out.

Also, I hear all these stories about maintaining at a certain level, but I never hear anyone mention the 20-40mgs p.r.n.(as needed{stressful situations}) that should also be included. If a person feels the urge, don't forget you can take the p.r.n. dose.

Also, IMO, the maintenance dose is not cast in stone. Stress and anxiety are not constants in one's life. A new job, family tragedy or illness, etc., can increase your stress level for quite some time.
I feel that if you find yourself having to take your p.r.n. dose frequently during the week, you should raise your maintenance dose and you still bring the 20-40mgs p.r.n. along with your new maintenance dose.
Then, later, if your life has settled down some what, and you find you are not using your p.r.n. dose, maybe you could lower it a little.
I see nothing wrong with regulating your maintenance dose as you see fit, to keep the cravings away.
This , to me, would be far better than falling off the cliff and ending up back at square one, and letting the old, deadly drinking habits return.

Just a thought
Knobert :thumbsup:

And by the way, congrats Neo---indifference is pretty neat, ain't it

[neophyte]

As for an update, I had 2 glasses of wine last night and didn't go for more, though the inclining was there. I wasn't planning on drinking but did anyway... more the reason to go back up in dose. I'm not looking forward to the somnolence, that to me was the worst SE, as id nod off at my desk at work.

[neophyte]

I remember reading some medical literature where by it recommended that the patient first find their indifference dose, reduce slowly until cravings returned, then bring the dose up a bit higher as a maintenance dose.

It mentioned that the maintenance dose observed was around 2/3 the switch dose. In my case my switch was 300mg, now on 200 with some cravings. So sounds right on the money.

Does anyone remember where this was mentioned?

[knobert]

Hi Neo

The first part of your post on how to step down is from the Baclofen Prescribing Guide. The link is in your signature. Also, their observed maintenance doses are listed there. These guys have treated over 1500 baclofen cases. I do not know of any other document with more experience.

Take care
Knobert

Continuing treatment

When the desired dose is reached and it is well tolerated, it is recommended to stay at that dose for2 to 3 months (sometimes less and sometimes more) and then try to reduce the dose to find thelowest effective dose. There is no established pattern as to how to reduce the dose. One way todetermine the effective dose is to reduce the dose until the urge to drink returns, and then increasethe dosage one level above this dose. The decrease can be done either very slowly (10 mg per week)or in larger increments (back to two-thirds of the dose) and stay at that level for 1 or 2 months. The maintenance dose is often between one third and half the maximum dose reached.