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Usual Adult Dose for Cerebral Spasticity
INTRATHECAL SCREENING PHASE: Prior to pump implantation for chronic infusion, patients must show a positive response to an intrathecal bolus dose in a screening trial.
-First Screening Dose: 50 mcg (in a volume of 1 mL) administered into the intrathecal space by barbotage over at least 1 minute; observe patient for 4 to 8 hours for a positive response
-Second Screening Dose: (if no positive response to first screening dose): 75 mcg (in a volume of 1.5 mL) bolus dose administered 24 hours after the first screening dose; observe patient for 4 to 8 hours for a positive response
-Third Screening Dose: (if no positive response to second screening dose): 100 mcg (in a volume of 2 mL) bolus dose administered 24 hours after the second screening dose; observe patient for 4 to 8 hours for a positive response; if no positive response to third screening dose, the patient should not be considered for chronic intrathecal therapy
INTRATHECAL POST-IMPLANT DOSE TITRATION PERIOD:
-The screening dose that received a positive response should be doubled and administered over 24 hours, unless the efficacy of the bolus dose was maintained for more than 8 hours, in which case the starting daily dose should be the screening dose delivered over 24 hours.
-No dose increases should be given in the first 24 hours (i.e., until steady state is achieved).
-ADULT PATIENTS WITH SPASTICITY OF SPINAL CORD ORIGIN: After the first 24 hours, the daily dosage should be increased slowly by 10% to 30% increments and only once every 24 hours, until the desired effect is achieved.
-ADULT PATIENTS WITH SPASTICITY OF CEREBRAL ORIGIN: After the first 24 hours, the daily dose should be increased slowly by 5% to 15% only once every 24 hours, until the desired effect is achieved.
INTRATHECAL MAINTENANCE DOSING FOR SPASTICITY OF SPINAL CORD ORIGIN:
-During periodic refills of the pump, the daily dose may be increased by 10% to 40%, but no more than 40%, to maintain adequate symptom control.
-The daily dose may be reduced by 10% to 20% if patients experience side effects; most patients require gradual increases in dose to maintain optimal response during chronic therapy
-Maintenance dosage for long term continuous infusion: 12 to 2003 mcg/day, with most patients adequately maintained on 300 to 800 mcg/day; there is limited experience with daily doses greater than 1000 mcg/day.