How is ITB dosed for the treatment of spasticity?

Updated: Mar 01, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

The screening process requires the administration of an intrathecal test dose of baclofen (typically 50 mcg, usually not to exceed 100 mcg) via lumbar puncture. Peak effect of the drug usually occurs within 4 hours. Patients who respond positively to the test dose can be considered for long-term ITB therapy. The test dose must be monitored closely in a fully equipped and staffed setting because of the rare risk of respiratory arrest and other life-threatening adverse effects.

The initial total daily dose of ITB after implantation may be up to double the screening dose that resulted in a beneficial response. Intrathecal doses are 100 times less than the oral dose required to produce similar side effects so caution should be exercised when adjusting the pump.


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