Possible drug interaction with CYP450 inhibitors Rare but serious adverse effects are arrhythmias, seizures, myocardial infarctionĥ-mg dose as effective as 10-mg, with fewer adverse effectsĪvoid in older patients and in patients with glaucoma Hepatoxicity (rare) discontinue with elevated liver function testĪvoid use in patients with hepatic impairmentĥ mg three times daily may increase to 10 mg three times dailyĪnticholinergic effect (drowsiness, dry mouth, urinary retention, increased intraocular pressure) Possible respiratory depression when combined with benzodiazepines, barbiturates, codeine or its derivatives, or other muscle relaxantsĬontraindicated in acute intermittent porphyriaĪdults: 250 to 750 mg three to four times dailyĬhildren: 125 to 500 mg three to four times daily or 20 mg per kg daily in three or four divided doses
Physical or psychological dependence may occur withdrawal symptoms may occur with discontinuation Rare idiosyncratic reactions (mental status changes, transient quadriplegia, and temporary loss of vision) after first dose may require hospitalizationĪllergy-type reactions may occur after the first to fourth dose may be mild (e.g., cutaneous rash) or more severe (e.g., asthma attack, angioneurotic edema, hypotension, or anaphylactic shock) antihistamines, epinephrine, or corticosteroids may be needed Not recommended for children younger than 12 years Because of limited comparable effectiveness data, choice of agent should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. The potential adverse effects should be communicated clearly to the patient. Adverse effects, particularly dizziness and drowsiness, are consistently reported with all skeletal muscle relaxants. Methocarbamol and metaxalone are less sedating, although effectiveness evidence is limited.
The sedative properties of tizanidine and cyclobenzaprine may benefit patients with insomnia caused by severe muscle spasms. Cyclobenzaprine is the most heavily studied and has been shown to be effective for various musculoskeletal conditions. Comparison studies have not shown one skeletal muscle relaxant to be superior to another. Systematic reviews and meta-analyses support using skeletal muscle relaxants for short-term relief of acute low back pain when nonsteroidal anti-inflammatory drugs or acetaminophen are not effective or tolerated. In addition, these drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain. However, evidence of their effectiveness consists mainly of studies with poor methodologic design. Skeletal muscle relaxants are widely used in treating musculoskeletal conditions.
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