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Maintenance TherapySpasticity of Spinal Cord Origin PatientsThe clinical goal is to maintain muscle tone as close to normal as possibleand to minimize the frequency and severity of spasms to the extent possiblewithout inducing intolerable side effectsVery oftenthe maintenance dose needs to be adjusted during the first few months of therapy while patients adjust to changes in life style due to the alleviation of spasticityDuring periodic refills of the pumpthe daily dose may be increased by 10-40but no more than 40to maintain adequate symptom controlThe daily dose may be reduced by 10-20if patients experience side effectsMost patients require gradual increases in dose over time to maintain optimal response during chronic therapyA sudden large requirement for dose escalation suggests a catheter complicationi.ecatheter kink or dislodgementMaintenance dosage for long term continuous infusion of LIORESAL INTRATHECALbaclofen injectionhas ranged from 12 mcg/day to 2003 mcg/daywith most patients adequately maintained on 300 micrograms to 800 micrograms per dayThere is limited experience with daily doses greater than 1000 mcg/dayDetermination of the optimal LIORESAL INTRATHECAL dose requires individual titrationThe lowest dose with an optimal response should be usedSpasticity of Cerebral Origin PatientsThe clinical goal is to maintain muscle tone as close to normal as possible and to minimize the frequency and severity of spasms to the extent possiblewithout inducing intolerable side effectsor to titrate the dose to the desired degree of muscle tone for optimal functionsVery often the maintenance dose needs to be adjusted during the first few months of therapy while patients adjust to changes in life style due to the alleviation of spasticityDuring periodic refills of the pumpthe daily dose may be increased by 5-20but no more than 20to maintain adequate symptom controlThe daily dose may be reduced by 10-20if patients experience side effectsMany patients require gradual increases in dose over time to maintain optimal response during chronic therapyA sudden large requirement for dose escalation suggests a catheter complicationi.ecatheter kink or dislodgementMaintenance dosage for long term continuous infusion of LIORESAL INTRATHECALbaclofen injectionhas ranged from 22 mcg/day to 1400 mcg/daywith most patients adequately maintained on 90 micrograms to 703 micrograms per dayIn clinical trialsonly 3 of 150 patients required daily doses greater than 1000 mcg/dayPediatric PatientsUse same dosing recommendations for patients with spasticity of cerebral originPediatric patients under 12 years seemed to require a lower daily dose in clinical trialsAverage daily dose for patients under 12 years was 274 mcg/daywith a range of 24 to 1199 mcg/dayDosage requirement for pediatric patients over 12 years does not seem to be different from that of adult patientsDetermination of the optimal LIORESAL INTRATHECAL dose requires individual titrationThe lowest dose with an optimal response should be usedPotential need for dose adjustments in chronic useDuring long term treatmentapproximately 528/627of patients become refractory to increasing dosesThere is not sufficient experience to make firm recommendations for tolerance treatmenthoweverthistolerancehas been treated on occasionin hospitalby adrug holidayconsisting of the gradual reduction of LIORESAL INTRATHECAL over a 2 to 4 week period and switching to alternative methods of spasticity managementAfter thedrug holidayLIORESAL INTRATHECAL may be restarted at the initial continuous infusion doseStability Parenteral drug buy meds from india. products should be inspected for particulate matter and discoloration prior to administrationwhenever solution and container permitDelivery Specifications The specific concentration that should be used depends upon the total daily dose required as well as the delivery rate of the pumpLIORESAL INTRATHECAL may require dilution when used with certain implantable pumpsPlease consult manufacturer's manual for specific recommendationsPreparation InstructionScreening Use the 1 mL screening ampule only50 mcg/mLfor bolus injection into the subarachnoid spaceFor a 50 mcg bolus doseuse 1 mL of the screening ampuleUse 1.5 mL of 50 mcg/mL baclofen injection for a 75 mcg bolus doseFor the maximum screening dose of 100 mcguse 2 mL of 50 mcg/mL baclofen injection2 screening ampulesMaintenance For patients who require concentrations other than 500 mcg/mL or 2000 mcg/mLLIORESAL INTRATHECAL must be dilutedLIORESAL INTRATHECAL must be diluted with sterile preservative free Sodium Chloride for InjectionU.S.PDelivery RegimenLIORESAL INTRATHECAL is most often administered in a continuous infusion mode immediately following implantFor those patients implanted with programmable pumps who have achieved relatively satisfactory control on continuous infusionfurther benefit may be attained using more complex schedules of LIORESAL INTRATHECAL deliveryFor examplepatients who have increased spasms at night may require a 20increase in their hourly infusion rateChanges in flow rate should be programmed to start two hours before the time of desired clinical effect.
Continuous InfusionLIORESAL INTRATHECAL'S antispastic action is first seen at 6 to 8 hours after initiation of continuous infusionMaximum activity is observed in 24 to 48 hours.
Considerations based on experience with oral LIORESALbaclofen USPA dose-related increase in incidence of ovarian cysts was observed in female rats treated chronically with oral LIORESALOvarian cysts have been found by palpation in about 4of online viagra shipped from the us. the multiple sclerosis patients who were treated with oral LIORESAL for up to one yearIn most cases these cysts disappeared spontaneously while patients continued to receive the drugOvarian cysts are estimated to occur spontaneously in approximately 1to 5of the normal female population.
Model 8565two ampuleseach contains 10 mg/20 mL500 mcg/mLNDC 58281-560-02
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