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  1. Baclofen Questionnaire Whether baclofen worked for you or not, we want to know all about it. Do you consider your experience with baclofen a success or a failure? Did you have side effects ? The information we gather will be consolidated to give newcomers and physicians an idea of protocols people have used and how it worked out. Please answer these questions: 1. Success or failure ? 2. How long did it take? 3. When you started baclofen, how many milligrams did you take per day? 4. How quickly and at what rate did you increase your dosage ? 5. At what times did you take your doses? 6. If you were successful, did you titrate down? At what rate? 7. What is your current baclofen dose per day? 8. Did you reduce your dose after success/failure? 9. List and rate your side effects on the scale below. Also note if side effects diminished after time or at difference dosages. a) None, or weak b) Bearable c) Uncomfortable but not handicapping d) Handicapping (vertigo, nausea, vomiting, sweating, somnolence, insomnia) e) Debilitating (not being able to work or perform tasks and/or having to decrease the intake of baclofen) f) Abandoned treatment due to side effects 10. How much and how often did you drink before you began treatment with baclofen? 11. What time of the day did you have cravings for alcohol? 12. During your treatment, did you reduce any other medications (for example, benzodiazepines or antidepressants). If ‘yes’, which and how much? If you are new to baclofen and want more information, or you are a physician who is interested in prescribing baclofen, please see HERE for more information.
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