What is the dosing of ITB maintenance therapy for spasticity?

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

About 60 days following surgery or when a stable dose program has been established, dose delivery can start to be fine-tuned. Maintenance doses of ITB are as follows:

  • For spasticity of spinal cord origin, the dose ranges from 12-2000 mcg/day, with most patients requiring 300-800 mcg/day

  • Patients with spasticity of cerebral origin receive doses ranging from 22-1400 mcg/day; for most patients, doses of 90-703 mcg/day result in therapeutic benefits

  • For children younger than 12 years, the average daily dose is 274 mcg/day, with a range of 24-1199 mcg/day

The dose may be increased if greater therapeutic benefits are needed, or reduced to alleviate adverse effects. Dose should always be reduced in a stepwise fashion. Sudden withdrawal of ITB can result in cardiovascular instability, fever, and rash and requires emergency treatment. The pump's reservoir must be refilled every 4-12 weeks, depending on the daily dose. The pump hardware can last 4-6 years, depending upon the battery life, and generally is replaced within 4-5 years.


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