What is Carisoprodol and What is Carisoprodol Side Effects ?

Carisoprodol ( Generic Soma ) is a controlled substance and you can not buy it online. Buying Carisoprodol or Selling Carisoprodol online are both illegal. For more Muscle Relaxant prescription information, please check this link.

If you want to buy Carisoprodol online, I suggest you buy Zanaflex, Flexeril, or other muscle relaxant instead.

What is carisoprodol?

Carisoprodol is a muscle relaxer that blocks pain sensations between the nerves and the brain.

Carisoprodol is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.

Carisoprodol should only be used for short periods (up to two or three weeks) because there is no evidence of its effectiveness in long term use and most skeletal muscle injuries are generally of short duration. Carisoprodol is considered a controlled substance in the United States.

Important Information

You should not take carisoprodol if you have porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

Carisoprodol may be habit-forming. Never share this medicine with another person. Misuse of habit-forming medicine can cause addiction, overdose, or death.

Carisoprodol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase drowsiness and dizziness caused by this medicine.

You may have withdrawal symptoms when you stop using this medicine after using it over a long period of time. Do not stop using this medication suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

How to use Carisoprodol

Take this medication by mouth with or without food as directed by your doctor. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

The dosage is based on your medical condition and response to treatment. This medication should only be used short-term (for 3 weeks or less) unless directed by your doctor.

If you suddenly stop using this medication, you may have withdrawal symptoms (such as stomach cramps, trouble sleeping, headache, nausea). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used carisoprodol for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.

Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.

Tell your doctor if your condition persists after 2 to 3 weeks or if it worsens.

Before taking this medicine

You should not use this medicine if you are allergic to carisoprodol or meprobamate, or if you have:

porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

Tell your doctor if you have ever had:

liver disease;
kidney disease; or
a seizure.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

Carisoprodol can pass into breast milk and may cause drowsiness in a nursing baby. Tell your doctor if you are breast-feeding.

This medicine is not approved for use by anyone younger than 16 years old.

Older adults may be more sensitive to the effects of this medicine.

How should I take carisoprodol?

Take carisoprodol exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Carisoprodol may be habit-forming. Misuse can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.

Carisoprodol is usually taken 3 times per day and at bedtime and should be only be taken for 2 or 3 weeks.. Call your doctor if your symptoms do not improve, or if they get worse. Follow your doctor’s dosing instructions very carefully.

Do not stop using this medicine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Carisoprodol is only part of a complete program of treatment that may also include rest, physical therapy, or other pain relief measures. Follow your doctor’s instructions.

Store at room temperature away from moisture and heat.

Keep track of your medicine. Carisoprodol is a drug of abuse and you should be aware if anyone is using it improperly or without a prescription.

Carisoprodol dosing information

Usual Adult Dose for Muscle Spasm:

250 to 350 mg orally 3 times a day and at bedtime
Duration of therapy: Up to 2 to 3 weeks

Comments:
-This drug should only be used for short periods (up to 2 or 3 weeks) as there is inadequate evidence of effectiveness for more prolonged use and acute, painful musculoskeletal conditions are generally of short duration.

Use: For the relief of discomfort associated with acute, painful musculoskeletal conditions

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of carisoprodol can be fatal, especially if you take it with alcohol or with other drugs that can slow your breathing.

Overdose symptoms may include vision problems, confusion, hallucinations, muscle stiffness, loss of coordination, weak or shallow breathing, fainting, seizure, or coma.

What should I avoid while taking carisoprodol?

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Carisoprodol side effects

Get emergency medical help if you have signs of an allergic reaction to carisoprodol: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using this medicine and call your doctor at once if you have:

- - a seizure (convulsions); or
  - high levels of serotonin in the body agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea.

Common carisoprodol side effects may include:

- - drowsiness;
  - dizziness; or
  - headache.

Carisoprodol Side Effects

Dizziness, drowsiness, or headache may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: confusion.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

All prescription is not recommended to use for a long time. You can use anti-aging products to become yonger and your muscle will become younger. We think exercising is the best way to relieve your pain. Exercising is a very good methods. Exercising can enhance your immune system and increase your muscle strength and make your nerve strong.
You can also take some nutrition from food. USANA Essentials – HealthPak, USANA Nutritions which contains USANA CellSentials™ is very good natural health nutrition for your health and can relieve your headache because of nutrition.

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Using carisoprodol with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Many drugs can interact with carisoprodol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medicine only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

How to treat muscle spasms ?

When you have muscle spasms, you can try following nature treatment:

1. 1. Stretching
  2. Massage
  3. Ice
  4. Heat
  5. Drink Water
  6. Mild exercising

If your muscle spasms doesnot improve, we suggest you take some natural foods to relieve your muscle spasm.

Some OTC medicines and Prescription for muscle spasms

Nonprescription remedies

There are several things you can take by mouth that may help with your muscle spasms:

- NSAIDs. Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) often bring relief by reducing inflammation and pain.
- Pickle juice. Drinking a small amount of pickle juice reportedly relieves cramping muscles within 30 to 35 seconds. This is thought to work by restoring electrolyte balance.
- Supplements. Salt tablets, vitamin B-12, and magnesium supplements are used by some people to treat and prevent muscle spasms. It’s important to note that there’s limited evidence to show that these are effective.
- Natural muscle relaxers. Natural muscle relaxants include drinking chamomile tea, adding capsaicin to foods, and improving your sleep.

Prescription medication for Muscle Spasms

If you have a persisting muscle spasm, especially if it’s severe, your doctor may prescribe a muscle relaxant or a pain medication.

Muscle relaxants used for muscle spasms are called centrally acting skeletal muscle relaxants (SMRs), and are often only prescribed for 2- to 3-week periods.

A List of Skeletal muscle relaxants

Drug Name	Reviews	Avg. Ratings
Antiflex Generic name: orphenadrine	1 review		10
Dantrium (Pro) Generic name: dantrolene	2 reviews		10
Vanadom Generic name: carisoprodol	1 review		9.0
Soma (Pro) Generic name: carisoprodol	180 reviews		8.9
Zanaflex (Pro) Generic name: tizanidine	100 reviews		7.7
Xeomin (Pro) Generic name: incobotulinumtoxinA	2 reviews		7.5
Amrix (Pro) Generic name: cyclobenzaprine	48 reviews		7.3
Myobloc (Pro) Generic name: rimabotulinumtoxinB	3 reviews		7.2
Skelaxin (Pro) Generic name: metaxalone	82 reviews		7.2
Lioresal (Pro) Generic name: baclofen	20 reviews		6.8
Norflex (Pro) Generic name: orphenadrine	22 reviews		6.5
Flexeril (Pro) Generic name: cyclobenzaprine	197 reviews		6.3
Robaxin (Pro) Generic name: methocarbamol	63 reviews		6.3
Lorzone (Pro) Generic name: chlorzoxazone	21 reviews		6.2
Dysport (Pro) Generic name: abobotulinumtoxinA	7 reviews		6.1
Botox (Pro) Generic name: onabotulinumtoxinA	350 reviews		5.9
Parafon Forte DSC (Pro) Generic name: chlorzoxazone	3 reviews		5.9
Fexmid (Pro) Generic name: cyclobenzaprine	4 reviews		5.8
Gablofen (Pro) Generic name: baclofen	3 reviews		5.8
Robaxin-750 Generic name: methocarbamol	39 reviews		5.6
Lioresal Intrathecal Generic name: baclofen	3 reviews		5.2
Botox Cosmetic (Pro) Generic name: onabotulinumtoxinA	11 reviews		4.9
Comfort Pac with Cyclobenzaprine Generic name: cyclobenzaprine	2 reviews		4.5
Orfro Generic name: orphenadrine	0 reviews		3.0
Kemstro Generic name: baclofen	0 reviews		2.0
Dantrium Intravenous (Pro) Generic name: dantrolene	0 reviews	Add rating
Mio-Rel Generic name: orphenadrine	0 reviews	Add rating
Orphenate Generic name: orphenadrine	0 reviews	Add rating
Ozobax (Pro) Generic name: baclofen	0 reviews	Add rating
Paraflex Generic name: chlorzoxazone	0 reviews	Add rating
Remular-S Generic name: chlorzoxazone	0 reviews	Add rating
Revonto (Pro) Generic name: dantrolene	0 reviews	Add rating
Ryanodex (Pro) Generic name: dantrolene	0 reviews	Add rating

Although skeletal muscle relaxants are recommended for short-term use in the treatment of musculoskeletal pain, approximately 44.5% of users remain on them for more than a year.

Due to CNS depression, cyclobenzaprine, metaxalone, orphenadrine (Norflex, others), methocarbamol (Robaxin, others), carisoprodol, and chlorzoxazone (Lorzone, Parafon Forte DSC, others) are on the American Geriatrics Society’s Beers List of inappropriate drugs for elderly patients.

Despite this, approximately 300,000 annual prescriptions for skeletal muscle relaxants (15%) are issued to patients older than 65 years of age.

Skeletal muscle relaxants represent a diverse pharmacotherapeutic group of medications across several chemical classes that are structurally dissimilar. These agents are effective for spasticity, skeletal muscle spasms, or both.

Because of the breadth of pharmacologic mechanisms and variable pharmacokinetics, the drugs have a huge range of AEs and potential drug interactions.

Considering that these agents are most often used in the elderly and also as adjuvants for the treatment of chronic pain patients with multiple comorbidities who are likely receiving a polypharmaceutical regimen (including opioids), skeletal muscle drug selection for each patient requires careful attention to these factors.

What is muscle spasms and what maybe the reasons of muscle spasms ?

What is a muscle spasm?

A muscle spasm, or muscle cramp, is an involuntary contraction of a muscle. Muscle spasms occur suddenly, usually resolve quickly, and are often painful.

A muscle spasm is different than a muscle twitch. A muscle twitch, or fasciculation, is an uncontrolled fine movement of a small segment of a larger muscle that can be seen under the skin.

Muscle Spasm facts

Spasms can affect many different types of muscles in the body, leading to many different symptoms.
Spasms of skeletal muscles are most common and are often due to overuse and muscle fatigue, dehydration, and electrolyte abnormalities. The spasm occurs abruptly, is painful, and is usually short-lived. It may be relieved by gently stretching the muscle.
If muscle spasms are especially painful, if they do not resolve or if they recur, medical care should be accessed to look for other possible underlying causes.
Smooth muscles that are within the walls of hollow organs (like the colon) can go into spasm, causing significant pain. Often this pain is colicky, meaning that it comes and goes. Examples include the pain associated with menstrual cramps, diarrhea, gallbladder pain, and passing a kidney stone.
A special form of muscle spasms are the dystonias where an abnormality perhaps exists with the chemicals that help transmit signals within the brain. Examples include torticollis and blepharospasm. Treatment may include medications to help restore the neurotransmitter levels to normal and Botox injections to paralyze the affected muscle and relieve the spasm.

What are common causes of muscle spasms?

There are a variety of causes of muscle spasms, and each depends upon predisposing factors, the part of the body involved, and the environment that the body is in.

Spasms may occur when a muscle is overused, tired, previously injured, or strained. The spasm may occur if the muscle has been overstretched or if it has been held in the same position for a prolonged period of time. In effect, the muscle cell runs out of energy and fluid and becomes hyperexcitable, resulting in a forceful contraction. This spasm may involve part of a muscle, the whole muscle, or even adjacent muscles.

- Overuse as a cause of skeletal muscle spasm is often seen in athletes who are doing strenuous exercise in a hot environment. This is also an occupational issue with construction workers or others working in a hot environment. Usually, the spasms will occur in the large muscles that are strained, being asked to do the work. When this occurs associated with heat exposure, the condition is also known as heat cramps.

Overuse can also occur with routine daily activities like shoveling snow, or mowing or raking grass, causing muscle spasms of the neck, shoulder, and back.

- Unfamiliar exercise activities can also cause muscle spasms to occur. Abdominal spasms can occur when a person decides to begin working their abdominal muscles by doing sit-ups and repeating too many too quickly.

Writer’s cramps of the hand and fingers are similarly caused by prolonged use of the small muscles in the hand and the overused muscles cramp. People will routinely rest and stretch their fingers either to prevent or treat this situation.

- It is commonly thought that dehydration and depletion of electrolytes will lead to muscle spasm and cramping. Muscle cells require enough water, glucose, sodium, potassium, calcium, and magnesium to allow the proteins within them to develop an organized contraction. Abnormal supply of these elements can cause the muscle to become irritable and develop spasm.
- Atherosclerosis or narrowing of the arteries (peripheral artery disease) may also lead to muscle spasm and cramps, again because an inadequate blood supply and nutrients are delivered to the muscle. Peripheral artery disease can decrease the flow of blood to the legs, causing pain in the legs with activity. There may also be associated muscle cramps.
- Leg spasms are often seen related to exercise, but cramps may also be seen at night involving calf and toe muscles. Nocturnal leg cramps and restless legs syndrome are considered a type of sleep disturbance. Their prevalence increases with age and often a precise cause is not found.
- Chronic neck and back pain can lead to recurrent muscles spasms. Large muscle groups make up the trunk, including the neck, chest wall, upper back, lower back, arms, and legs. Spasms in these muscles can be a result of an injury or they may develop over time because of arthritic changes in the spine. Obesity can cause stress and strain of the core muscles of the trunk, resulting in muscle cramps of the neck and upper and lower back. Systemic illnesses like diabetes, anemia (low red blood cell count), kidney disease, and thyroid and other hormone issues are also potential causes of muscle spasms.
- Diseases of the nervous system, such as amyotrophic lateral sclerosis, multiple sclerosis, or spinal cord injury, can be associated with muscle spasm.
- Smooth muscle can also go into spasm. When a hollow structure filled with air or fluid is squeezed by the muscle spasm, significant pain may occur, since the fluid or air cannot be compressed. For example, smooth muscle in the intestinal wall can go into spasm, causing waves of pain called colic. Colicky pain which tends to come and go may also occur within the bile duct that empties the gallbladder and may develop after eating.
- When kidney stones try to pass through the urinary tract, the smooth muscles that are in the walls of the ureter (that connects the kidney to the bladder) may spasm rhythmically and cause significant pain. Often this type of pain is associated with nausea and vomiting and is called renal colic.
- Muscles that surround the esophagus can go into spasm when acid reflux causes irritation of the lining of the esophagus, resulting in esophagitis or GERD (gastroesophageal reflux disease).
- Diarrhea can be associated with colicky pain, where the muscles within the colon wall spasm just before a watery bowel movement.
- Menstrual cramps occur when the walls of the uterus contract forcefully.
- The coronary arteries that supply the heart muscle with blood also have smooth muscle within their walls that may go into spasm. This can cause chest pain that may be indistinguishable from the pain of coronary artery disease (where plaque has accumulated and narrowed the arteries). Coronary artery spasm often occurs in smokers or those who have high cholesterol blood levels. Coronary artery spasm may be triggered by stress, alcohol withdrawal, stimulant drug abuse (especially cocaine) or medications that can constrict or narrow blood vessels. Coronary artery spasm is also known as Prinzmetal’s angina.

- Dystonias are movement disorders where groups of muscles forcefully contract and cause twisting. Uncontrolled repetitive movements and the inability to maintain normal posture may be the result of this type of muscle spasm and cramping. The symptoms may be very mild initially but gradually progress to become more frequent and aggressive. Occasionally, there is no progression. Examples of this type of muscle spasm include torticollis (where the neck muscles spasm and cause the head to turn to one side), blepharospasm (where there is uncontrolled blinking of the eyes), and laryngeal dystonia that affects the muscles that control speech. Dystonias may be caused by abnormally functioning neurotransmitter chemicals within part of the brain called the basal ganglia. These chemicals (serotonin, dopamine, acetylcholine, and GABA) are required to properly send messages between brain cells that begin muscle contraction. Dystonia symptoms may occur as a complication of stroke.

What are risk factors for muscle spasms?

Most people are at risk for developing a muscle spasm at one time in their life, from infant colic to kidney stones. The risks differ depending upon the person’s past medical history, their occupation, and level of physical activity. Examples include the following:

- - Construction and factory workers who work in hot environments are at risk for becoming dehydrated and developing heat cramps. This same situation can occur in athletes, both elite and recreational.
  - Patients with peripheral artery disease can develop leg cramps at night. Risk factors are the same as for stroke and heart attack: high blood pressure, high cholesterol, diabetes, and smoking.
  - Patients who have underlying neurologic disorders are at risk for developing muscle spasms.

Muscle Relaxants for Back Pain and Neck Pain

Muscle relaxants are medications that help reduce muscle spasms, which are involuntary muscle contractions caused by a spine-related problem, such as whiplash, fibromyalgia, or low back strain.

Often, muscle spasms cause severe pain and may limit your mobility.

If you want to know more Natural Muscle Relaxant, please check this link:

What is the Best Natural Muscle Relaxants?

When are muscle relaxants prescribed?

Muscle relaxants are used to relieve muscle spasms which may result from some conditions which affect the nervous system, such as:

Multiple sclerosis.
Motor neurone disease.
Cerebral palsy.
Long-term injuries to the head or back.

Cannabis extract is usually started by a consultant in a hospital. It is normally prescribed for people with multiple sclerosis who have tried other muscle relaxants which are not working. In most cases it is given as a four-week trial to see if it helps with symptoms.

In addition, diazepam may be used to relieve lower back pain, or neck pain in conditions such as whiplash. It is addictive so cannot be used for more than a week or two. Methocarbamol is also used for muscle spasm in people with low back pain. Much of the pain in these conditions is due to muscle spasm. The cause of the spasm is different to the nervous system conditions above.

How should muscle relaxants be taken?

These medicines are usually taken by mouth (tablets, capsules or liquids). In general, your doctor will start off with a low dose and increase this gradually over a number of weeks. This is in order to help your body get used to these medicines. Injections into the back are always started in the hospital.

Cannabis extract is a spray for the mouth. It should be sprayed under the tongue or on to the inside of the cheek once or twice a day. Always change the area in your mouth where you spray, to prevent irritation of the mouth. Like other muscle relaxants you will normally start off with a low dose. The number of sprays used is normally increased over a number of days.

What are the possible side-effects?

As with most medicines, muscle relaxants have a number of possible side-effects. However, not everyone experiences them and they usually improve as your body adjusts to the new medicine. Most muscle relaxants cause muscle weakness as a side-effect. It is not possible in this leaflet to list all the possible side-effects for these medicines. However, see below for a list of the most common side-effects. For more detailed information, see the leaflet that comes with the medicine packet.

Baclofen – feeling sick, tiredness, drowsiness, problems with eyesight, weakness, dizziness, light-headedness, headache, dry mouth, breathing difficulties, aching muscles, sleeplessness or nightmares, feeling anxious or agitated, confusion, unsteadiness, increased need to pass urine, shakiness, increased sweating, and skin rash.
Dantrolene – feeling dizzy, sleepy, tired, or generally unwell, diarrhoea, feeling or being sick, tummy (abdominal) pain, headache, loss of appetite, rash, speech or sight difficulties, high temperature (fever), chills, difficulty in breathing, seizures. It may also cause inflammation of the lining around the heart (sometimes with fluid in the lungs). Liver toxicity is also a possible side-effect of dantrolene.
Diazepam – feeling sleepy, weak, or light-headed, forgetfulness, feeling confused or unsteady, feeling (or being) aggressive.
Methocarbamol – forgetfulness, allergic reactions, being anxious, blurred vision, a slow heart rate, being confused or dizzy, headache, heartburn, feeling or being sick, itching, rash, and low blood pressure.
Cannabis extract – feeling dizzy, depressed mood, diarrhoea or constipation, mouth ulcers or pain, feeling tired or sick, appetite changes. Hallucinations have also been reported.

Who cannot take muscle relaxants?

For a full list of people who should not take each type of muscle relaxant, refer to the specific leaflet for that medication.

Baclofen should not usually be given to people who have a stomach ulcer, epilepsy, mental health problems or diabetes.
Dantrolene should not be given to people with liver, heart or breathing problems.
Diazepam should be avoided in people who have severe breathing difficulties – for example, people who have myasthenia gravis and people with lung problems.
Tizanidine should not usually be given to elderly people, or people who have severe problems with their liver.
Methocarbamol should not be used for people who have myasthenia gravis or severe breathing problems. It also should not be used in people with epilepsy or brain damage.
Cannabis extract can only be prescribed by specialists for people with multiple sclerosis. People who have a personal or family history of hallucinations or delusions or any other severe psychiatric disorder should not take cannabis extract.

Other considerations

Muscle relaxants are sometimes used to treat other conditions – for example, diazepam is sometimes used to treat anxiety or difficulty with sleeping (insomnia). It is given as a pre-medication (often called a ‘pre-med’) before an operation, particularly during procedures that may cause anxiety or discomfort.

It can also be used to treat seizures. Rectal diazepam tubes may be prescribed for this, as they are useful if a quick effect is needed or if it is not possible to give the medicine by mouth.

Some medicines that are given by injection into the vein during surgery are also known as muscle relaxants. They are sometimes called ‘neuromuscular blocking drugs’ and are used to relax the muscles during surgery. They work in a completely different way to baclofen, dantrolene, diazepam, tizanidine, and cannabis extract and are not discussed here.

There are a number of other things to consider when taking muscle relaxants:

These medicines can cause drowsiness. If you feel drowsy when taking these medicines, do not operate machinery, do not drive, and do not drink alcohol.
Baclofen should not be stopped suddenly. The dose should be lowered slowly over a few weeks and then stopped.
Diazepam – people who take this medicine continuously for more than two weeks can become dependent on it. This means that withdrawal symptoms occur if the tablets are stopped suddenly.

Your doctor may prescribe a muscle relaxant to ease muscle spasms, reduce pain, and help your muscles move better. When your muscles move better, it makes other spine pain treatments, such as physical therapy, stretching, and exercise, more effective.

Understanding Spasticity Versus Spasm

Muscle relaxants treat 2 conditions: spasticity and spasm. Spasticity is marked by long-term muscle contraction caused by a brain or spinal cord injury. Spasms, on the other hand, are localized and occur because of a musculoskeletal issue.

Prescription muscle relaxants fall into 2 groups: antispastics and antispasmodics.

- Antispastics are prescribed to treat spasticity caused by neurological disorders, such as cerebral palsy or spinal cord injury.
- Antispasmodics are used to treat occasional muscle spasms.

While some antispasmodics may treat spasticity in addition to spasms, antispastics should not be used to treat spasms.

Muscle Relaxants for Muscle Spasms

Muscle spasms are painful and may restrict mobility, which can limit your ability to perform even basic activities. Painful, tight muscles can also interfere with getting a good night’s sleep.

Muscle relaxants may help reduce pain, and improve movement and range of motion, but your doctor will likely recommend that you first try acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). In some cases, these over-the-counter medications will be enough to help alleviate your pain.

If your muscle pain persists, your doctor may prescribe a muscle relaxant in addition to your pain medication. Below are common muscle relaxants (the generic names are listed first, with a brand name example in parentheses):

Baclofen (Lioresal)
Carisoprodol (Soma)
Cyclobenzaprine (Amrix)
Metaxalone (Skelaxin)
Methocarbamol (Robaxin)

Special Considerations and Potential Muscle Relaxant Side Effects

Muscle relaxants for acute back or neck pain are usually prescribed to relieve short-term muscle pain—and some can be habit-forming. For these reasons, most doctors will write prescriptions with less than 2 weeks’ worth of medication. To reduce your risk of dependency or abuse, use your medication exactly as your doctor prescribes.

The most common side effects associated with muscle relaxants are drowsiness and dizziness. This is because muscle relaxants depress your central nervous system, making you less alert and attentive. As such, avoid alcohol and don’t perform tasks that require your complete attention, such as operating machinery or driving, while taking a muscle relaxant.

Muscle relaxants pose health risks when they are taken with certain medications and supplements, including opioids, sleep aid medications, and St. John’s wort. Make sure your doctor knows every medication and supplement you are taking before starting muscle relaxant therapy.

Muscle Relaxants: Part of a Multidisciplinary Treatment Plan

If your muscle pain doesn’t respond to over-the-counter medications, then muscle relaxants may be a good treatment option to alleviate your muscle spasms. For best results, muscle relaxants should be viewed as part of a treatment plan that may include gentle stretching, physical therapy, and exercise—not the sole treatment. As always, don’t hesitate to discuss your medications and comprehensive spine health plan with your doctor. A solid understanding of your therapeutic options is a strong defense against back pain.

List of Common Muscle Relaxers

Muscle relaxers are used in addition to rest, physical therapy, and other measures to relieve discomfort. They are typically prescribed for short-term use to treat acute, painful musculoskeletal conditions. Muscle relaxers are occasionally prescribed for chronic pain (pain lasting longer than 3 months).

If you want to talk about muscle relaxant in our muscle relaxant forums.

Muscle relaxers are not a class of drugs—meaning they do not all have the same chemical structure or work the same way in the brain. Rather, the term muscle relaxer is used to describe a group of drugs that act as central nervous system depressants and have sedative and musculoskeletal relaxant properties.

Muscle relaxers may be prescribed to treat back pain:

- - Early in the course of back pain, on a short-term basis, to relieve pain associated with muscle spasms
  - When back pain causes insomnia (for their sedative effect)

Muscle relaxers are also prescribed for other conditions such as fibromyalgia, multiple sclerosis, and seizure disorders.

There are several types of muscle relaxer medications commonly used to treat back pain.

Common Muscle Relaxants

Muscle relaxers are usually prescribed to treat back pain in conjunction with rest and physical therapy. Common muscle relaxants include:

- - Baclofen. Muscle tightness and muscle spasms, including those related to spine injuries, may be eased with baclofen. The medication may be helpful in treating multiple sclerosis and stabbing nerve pain. It is available as a tablet and can be taken by children as young as 12 years old. Some common side effects could include nausea and vomiting, confusion, drowsiness, headache, or muscle weakness. Baclofen is rated C in the FDA’s A through X pregnancy safety ranking for medications, with A being the safest. The C category means that the medication should only be used if the benefits outweigh the risks.
  - Benzodiazepines. In addition to treating anxiety, alcohol withdrawal, and seizure disorders, such as epilepsy, benzodiazepines can also treat muscle spasms and skeletal pain. Benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril), are typically only intended for short-term use. This limitation is due to their habit-forming potential and because they alter sleep cycles, leading to sleep difficulties once the drug is stopped. Benzodiazepines are sold as tablets, liquid, injections, and rectal gels. People who have myasthenia gravis, severe liver disease, serious breathing troubles, or some forms of glaucoma, should avoid taking diazepam. All benzodiazepines are rated D by the FDA for safety during pregnancy and are not recommended for women who are pregnant.

- - Carisoprodol (Soma). Carisoprodol relaxes muscles and eases pain and stiffness caused by acute bone and muscle problems, often caused by an injury. It is taken by mouth in tablet form and is also available in combination with aspirin or aspirin and codeine. Carisoprodol can be habit-forming, particularly if used in conjunction with alcohol or other drugs that have a sedative effect, including opioids (such as codeine). Common side effects include drowsiness, dizziness, and headache. People with a history of blood disorders, kidney or liver disease, and seizures may need to avoid Carisoprodol. It is rated C in the FDA’s pregnancy safety ranking for medications.
  - Chlorzoxazone (Lorzone). Chlorzoxazone is used for the relief of discomfort from acute, painful, musculoskeletal conditions. Chlorzoxazone is available as a tablet. Common side effects include drowsiness, dizziness, and nausea. Chlorzoxazone is not recommended for people with liver disease. It has not been rated by the FDA for safety during pregnancy.
  - Cyclobenzaprine (Amrix, Fexmid, FlexePax Kit, FusePaq Tabradol). Cyclobenzaprine eases stiffness and pain from muscle cramps, also called muscle spasms. It is available as a tablet and extended-release capsule. Cyclobenzaprine itself is not intended for long-term use (more than 2 to 3 weeks). Common side effects include blurred vision, dizziness or drowsiness, and dry mouth. It is not advised for those with an overactive thyroid, heart problems, or liver disease. Cyclobenzaprine is rated B by the FDA for safety during pregnancy, making it the safest muscle relaxant to use while pregnant.
  - Dantrolene (Dantrium). Dantrolene helps control chronic spasticity related to spinal injuries. It is also used for conditions such as stroke, multiple sclerosis, and cerebral palsy. Dantrolene is taken as a capsule or intravenous powder for injection. Drowsiness and sensitivity to light are common side effects. It can cause severe liver problems, and should not be taken by people with active liver disease. The FDA has given dantrolene a C rating for safety in pregnancy.
  - Metaxalone (Skelaxin, Metaxall, and Metaxall CP, Lorvatus PharmaPak). Metaxalone targets pain and muscle spasms from sprains, strains, and muscle injuries. It is available as a tablet or injection. Common side effects include drowsiness, dizziness, nausea, and vomiting. Metaxalone is generally not recommended for people with a known tendency to become anemic, and who have kidney or liver disease. Metaxalone may affect blood sugar tests for people with diabetes. The FDA has not rated metaxalone for safety during pregnancy.
  - Methocarbamol (Robaxin, Robaxin-750). Methocarbamol eases acute muscle and bone pain. It can be taken as a tablet or by injection. Common side effects include dizziness, headache, nausea, flushing, and blurred vision. Methocarbamol is generally not recommended to people with renal disease or failure, or a history of allergic reaction to the medication. The FDA has given methocarbamol a C rating for safety during pregnancy.
  - Orphenadrine. Orphenadrine is a medication used to relieve pain and stiffness caused by muscle injuries. It is available as an extended-release tablet. Common side effects include dry mouth, lightheadedness, difficult urination, heartburn, nausea and vomiting. It is generally not recommended to people with previous sensitivities to the ingredients, myasthenia gravis, those with glaucoma or certain types of ulcers. The FDA has given orphenadrine a C rating for safety during pregnancy.
  - Tizanidine (Comfort Pac with Tizanidine, Zanaflex). Tizanidine is used to treat muscle spasms caused by spinal cord injuries and other conditions such as multiple sclerosis. Tizanidine is available in tablet and capsule form and absorbs differently depending on whether it is taken on an empty stomach or with food. Common side effects include dry mouth, dizziness, constipation and tiredness. It should not be used by people taking fluvoxamine or ciprofloxacin or those who have liver disease. Tizanidine is rated in the C category for safety during pregnancy.

Sometimes the first muscle relaxers a doctor prescribes does not work as well as expected. It may be necessary to try an alternative if the initial prescription is not effective. Many drugs interact with muscle relaxers and a person should keep their health care provider informed of all prescription and non-prescription medications he or she is taking.

There is very little research regarding which muscle relaxers are most effective, so the choice of which medication—or whether to use one at all—is based on factors such as a person’s reaction to the medication and personal preferences, potential for abuse, possible drug interactions, and adverse side effects.

How should muscle relaxants be taken?

What are the possible side-effects?

Baclofen – feeling sick, tiredness, drowsiness, problems with eyesight, weakness, dizziness, light-headedness, headache, dry mouth, breathing difficulties, aching muscles, sleeplessness or nightmares, feeling anxious or agitated, confusion, unsteadiness, increased need to pass urine, shakiness, increased sweating, and skin rash.
Dantrolene – feeling dizzy, sleepy, tired, or generally unwell, diarrhoea, feeling or being sick, tummy (abdominal) pain, headache, loss of appetite, rash, speech or sight difficulties, high temperature (fever), chills, difficulty in breathing, seizures. It may also cause inflammation of the lining around the heart (sometimes with fluid in the lungs). Liver toxicity is also a possible side-effect of dantrolene.
Diazepam – feeling sleepy, weak, or light-headed, forgetfulness, feeling confused or unsteady, feeling (or being) aggressive.
Methocarbamol – forgetfulness, allergic reactions, being anxious, blurred vision, a slow heart rate, being confused or dizzy, headache, heartburn, feeling or being sick, itching, rash, and low blood pressure.
Cannabis extract – feeling dizzy, depressed mood, diarrhoea or constipation, mouth ulcers or pain, feeling tired or sick, appetite changes. Hallucinations have also been reported.

What is muscle relaxant ?

If you have neck or back pain, or you’re dealing with some other condition that causes muscle spasms, your doctor might prescribe a muscle relaxer (or muscle relaxant) for you.

Having a muscle spasm means that one or more of your muscles is contracting and the twitching or cramping is out of your control. It can happen for a lot of different reasons, and can sometimes be very painful.

While there are many different treatments for pain, your doctor may decide that a muscle relaxer is the best solution for you.

Muscle relaxers, or muscle relaxants, are medications used to treat muscle spasms or muscle spasticity.

Muscle spasms or cramps are sudden, involuntary contractions of a muscle or group of muscles. They can be caused by too much muscle strain and lead to pain. They’re associated with conditions such as lower back pain, neck pain, and fibromyalgia.

Muscle spasticity, on the other hand, is a continuous muscle spasm that causes stiffness, rigidity, or tightness that can interfere with normal walking, talking, or movement. Muscle spasticity is caused by injury to parts of the brain or spinal cord involved with movement. Conditions that can cause muscle spasticity include multiple sclerosis (MS), cerebral palsy, and amyotrophic lateral sclerosis (ALS).

Prescription drugs can help relieve the pain and discomfort from muscle spasms or spasticity. In addition, certain over-the-counter medications may be used to treat aches and pains associated with muscle spasms.

When You Might Need a Muscle Relaxer

Your doctor might first suggest you try an over-the-counter medicine like acetaminophen (Tylenol) or ibuprofen (Advil) to treat your pain. But if those don’t work, or you can’t take them because you have another issue like liver problems or ulcers, you may need to try a muscle relaxant.

Muscle relaxants are ideally prescribed for acute rather than chronic pain. They may be an option if pain is preventing you from getting enough sleep. Because muscle relaxants cause drowsiness, they can help you get rest when you take them at night.

Side Effects

No matter what kind of muscle relaxer you take, you’ll experience one or more side effects. Some muscle relaxants, however, can have potentially serious side effects, like liver damage. Your doctor will work with you to find the medication that makes the most sense for your situation.

The most common side effects include:

- - Tiredness, drowsiness, or sedation effect
  - Fatigue or weakness
  - Dizziness
  - Dry mouth
  - Depression
  - Decreased blood pressure

You shouldn’t drink alcohol while taking muscle relaxants. These medications make it hard to think and function normally, even if you take a low dose, so combining them with alcohol can increase your risk of an accident.

You also shouldn’t drive or operate heavy machinery while taking muscle relaxants. Some muscle relaxers start working within 30 minutes of taking them, and the effects can last anywhere from 4 to 6 hours.

Addiction and Abuse

Muscle relaxants can be addictive for some people. Taking them without a prescription, or taking more than your doctor has recommended, can increase your chances of becoming addicted. So can using them over a long period of time.

Almost all cases of addiction and abuse are due to the drug carisoprodol (Soma), which is considered a schedule IV controlled substance. That’s because when the drug breaks down in your body, it produces a substance called meprobamate that acts like a tranquilizer. People who become addicted to carisoprodol sometimes abuse the drug because it makes them feel relaxed.

Other kinds of muscle relaxants may be addictive too. Cyclobenzaprine (Flexeril) has also been linked to misuse and abuse.

With prolonged use you can become physically dependent on some muscle relaxants. This means that without the medication, you can have withdrawl symptoms. You may have insomnia, vomiting or anxiety when you stop taking it.

Prescription medications

Prescription medications are divided into two groups: antispasmodics and antispastics. Antispasmodics are used to treat muscle spasms, and antispastics are used to treat muscle spasticity. Some antispasmodics, such as tizanidine, can be used to treat muscle spasticity. However, antispastics should not be used to treat muscle spasms.

Antispasmodics: Centrally acting skeletal muscle relaxants (SMRs)

Centrally acting SMRs are used in addition to rest and physical therapy to help relieve muscle spasms. They’re thought to work by causing a sedative effect or by preventing your nerves from sending pain signals to your brain.

You should only use these muscle relaxants for up to 2 or 3 weeks. The safety of longer-term use is not yet known.

While antispasmodics can be used to treat muscle spasms, they have not been shown to work better than nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. In addition, they have more side effects than NSAIDs or acetaminophen.

The more common side effects of centrally acting SMRs include:

drowsiness
dizziness
headache
nervousness
reddish-purple or orange urine
lowered blood pressure upon standing

You should talk to your doctor about the benefits and risks of these medications for the treatment of your muscle spasms.

List of centrally acting SMRs

Generic name	Brand name	Form	Generic available
carisoprodol	Soma	tablet	yes
carisoprodol/aspirin	not available	tablet	yes
carisoprodol/aspirin/codeine	not available	tablet	yes
chlorzoxazone	Parafon Forte, Lorzone	tablet	yes
cyclobenzaprine	Fexmid, Flexeril, Amrix	tablet, extended-release capsule	tablet only
metaxalone	Skelaxin, Metaxall	tablet	yes
methocarbamol	Robaxin	tablet	yes
orphenadrine	Norflex	extended-release tablet	yes
tizanidine	Zanaflex	tablet, capsule	yes

Antispastics

Antispastics are used to treat muscle spasticity. They should not be used to treat muscle spasms. These drugs include:

Baclofen: Baclofen (Lioresal) is used to relieve spasticity caused by MS. It’s not fully understood how it works, but it seems to block nerve signals from the spinal cord that cause muscles to spasm. Side effects can include drowsiness, dizziness, weakness, and fatigue.

Dantrolene: Dantrolene (Dantrium) is used to treat muscle spasms caused by spinal cord injury, stroke, cerebral palsy, or MS. It works by acting directly on the skeletal muscle to relax the muscle spasm. Side effects can include drowsiness, dizziness, lightheadedness, and fatigue.

Diazepam: Diazepam (Valium) is used to relieve muscle spasms caused by inflammation, trauma, or muscle spasticity. It works by increasing the activity of a certain neurotransmitter to decrease the occurrence of muscle spasms. Diazepam is a sedative. Side effects can include drowsiness, fatigue, and muscle weakness.

List of antispastics

Generic name	Brand name	Form	Generic available
baclofen	Lioresal, Gablofen, Lioresal	tablet, injection	yes
dantrolene	Dantrium	tablet	yes
diazepam	Valium	oral suspension, tablet, injection	yes

Warnings for prescription muscle relaxants

Muscle relaxants such as carisoprodol and diazepam can be habit forming. Be sure to take your medication exactly as prescribed by your doctor.

Muscle relaxants can also cause withdrawal symptoms, such as seizures or hallucinations (sensing things that aren’t real). Do not suddenly stop taking your medication, especially if you’ve been taking it for a long time.

Also, muscle relaxants depress your central nervous system (CNS), making it hard to pay attention or stay awake. While taking a muscle relaxant, avoid activities that require mental alertness or coordination, such as driving or using heavy machinery.

You should not take muscle relaxants with:

alcohol
CNS depressant drugs, such as opioids or psychotropics
sleeping medications
herbal supplements such as St. John’s wort

Talk to your doctor about how you can safely use muscle relaxants if you:

are older than 65 years
have a mental health problem or brain disorder
have liver problems

Off-label medications for spasticity

Doctors can use certain medications to treat spasticity even when the drugs are not approved for that purpose by the U.S. Food and Drug Association (FDA). This is called off-label drug use. The following drugs are not actually muscle relaxants, but they can still help relieve symptoms of spasticity.

Benzodiazepines

Benzodiazepines are sedatives that can help relax muscles. They work by increasing the effects of certain neurotransmitters, which are chemicals that relay messages between your brain cells.

Examples of benzodiazepines include:

clonazepam (Klonopin)
lorazepam (Ativan)
alprazolam (Xanax)

Side effects of benzodiazepines can include drowsiness and problems with balance and memory. These drugs can also be habit forming.

Clonidine

Clonidine (Kapvay) is thought to work by preventing your nerves from sending pain signals to your brain or by causing a sedative effect.

Clonidine should not be used with other muscle relaxants. Taking it with similar drugs increases your risk of side effects. For instance, taking clonidine with tizanidine can cause very low blood pressure.

Clonidine is available in brand-name and generic versions.

Gabapentin

Gabapentin (Neurontin) is an anticonvulsant drug typically used to relieve seizures. It’s not fully known how gabapentin works to relieve muscle spasticity. Gabapentin is available in brand-name and generic versions.

Over-the-counter options for muscle spasms

OTC treatment is recommended as first-line therapy for muscle spasms caused by conditions such as acute lower back pain or tension headache. This means you should try OTC treatments before prescription medications.

OTC treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or a combination of both. Your doctor or pharmacist can help you choose an OTC treatment.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs work by blocking your body from making certain substances that cause inflammation and pain. NSAIDs are available in generic and brand-name versions. They’re typically sold over the counter. Stronger versions are available by prescription.

NSAIDs come as oral tablets, capsules, or suspensions. They also come as chewable tablets for children. Side effects of these drugs can include upset stomach and dizziness.

Examples of NSAIDs include:

ibuprofen (Advil, Motrin)
naproxen (Aleve)

Acetaminophen

Acetaminophen (Tylenol) is thought to work by blocking your body from making certain substances that cause pain. Acetaminophen is available in generic and brand-name versions. It comes as immediate-release and extended release oral tablets and capsules, orally disintegrating tablets, chewable tablets, and oral solutions.

The more common side effects of acetaminophen can include nausea and upset stomach.

What is the important information I should know before I take Cyclobenzaprine ?

You should not use cyclobenzaprine if you are allergic to it, or if you have:

- - a thyroid disorder;
  - heart block, heart rhythm disorder, congestive heart failure; or
  - if you have recently had a heart attack.

Cyclobenzaprine is not approved for use by anyone younger than 15 years old.

Do not use cyclobenzaprine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Some medicines can interact with cyclobenzaprine and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

Tell your doctor if you have ever had:

- - liver disease;
  - glaucoma;
  - enlarged prostate; or
  - problems with urination.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.

Older adults may be more sensitive to the effects of this medicine.

HOW SHOULD I TAKE CYCLOBENZAPRINE?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Cyclobenzaprine is usually taken once daily for only 2 or 3 weeks. Follow your doctor’s dosing instructions very carefully.

Swallow the capsule whole and do not crush, chew, break, or open it.

Take the medicine at the same time each day.

Call your doctor if your symptoms do not improve after 3 weeks, or if they get worse. Store at room temperature away from moisture, heat, and light.

Cyclobenzaprine Medline Plus Drug Information

Why is this medication prescribed?

Cyclobenzaprine is used with rest, physical therapy, and other measures to relax muscles and relieve pain and discomfort caused by strains, sprains, and other muscle injuries. Cyclobenzaprine is in a class of medications called skeletal muscle relaxants. It works by acting in the brain and nervous system to allow the muscles to relax.

How should this medicine be used?

Cyclobenzaprine comes as a tablet and an extended-release capsule to take by mouth. The tablet is usually taken with or without food three times a day. The extended-release capsule is usually taken with or without food once a day. Do not take this drug for more than 3 weeks without talking to your doctor. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cyclobenzaprine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release capsules whole; do not chew or crush them.

If you are not able to swallow the extended-release capsule whole, mix the contents of the capsule with applesauce. Eat the mixture right away and swallow without chewing. After you eat the mixture, take a drink, and swish and swallow to make sure that you have received all the medication.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking cyclobenzaprine,

tell your doctor and pharmacist if you are allergic to cyclobenzaprine, any other medications, or any of the ingredients in cyclobenzaprine tablets or capsules. Ask your pharmacist for a list of the ingredients.
tell your doctor if you are taking the following medications or have stopped taking them within the past two weeks: monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate). Your doctor will probably tell you not to take cyclobenzaprine if you are taking one of these medications.
tell your doctor and pharmacist what other prescription and nonprescription drugs, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: medications for allergies, coughs, or colds; barbiturates such as butabarbital (Butisol), phenobarbital, and secobarbital (Seconal); bupropion (Aplenzin, Forfivo XL, Wellbutrin, Zyban); meperidine (Demerol); sedatives; sleeping pills; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); selective serotonin and norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), milnacipran (Savella) and venlafaxine (Effexor); tranquilizers; tricyclic antidepressants (TCAs) such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); tramadol (Conzip, Ultram, in Ultracet); verapamil (Calan, Covera HS, Verelan, in Tarka); or any other medication for depression, mood, anxiety, or thought disorder. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with cyclobenzaprine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. ;
tell your doctor if you are recovering from a recent heart attack, or if you have an overactive thyroid gland. heart failure (condition in which the heart is unable to pump enough blood to the other parts of the body), or an irregular heartbeat, heart block, or other problems with the electrical impulses of your heart. Your doctor will probably tell you not to take cyclobenzaprine.
tell your doctor if you have increased pressure in the eye or glaucoma, difficulty urinating, or liver disease.
tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking cyclobenzaprine, call your doctor immediately.
talk to your doctor about the risks and benefits of taking cyclobenzaprine if you are 65 years of age or older. Older adults should not usually take cyclobenzaprine because it is not as safe or effective as other medications that can be used to treat the same condition.
you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how cyclobenzaprine affects you.
ask your doctor about the safe use of alcoholic beverages while you are taking cyclobenzaprine. Cyclobenzaprine can make the effects of alcohol worse.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for the missed one.

What side effects can this medication cause?

Cyclobenzaprine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

dry mouth
dizziness
nausea
constipation
heartburn
extreme tiredness

If you experience any of the following symptoms, call your doctor immediately:

skin rash
hives
swelling of the face or tongue
difficulty breathing or swallowing
irregular or fast heart rate
chest pain

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Store the extended-release capsule away from light.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

drowsiness
fast or irregular heartbeat
feeling agitated
confusion
trouble speaking or moving
dizziness
nausea
vomiting
hallucination (seeing things or hearing voices that do not exist)
tremor
loss of consciousness

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

Amrix^®
Flexeril^®

^¶This branded product is no longer on the market. Generic alternatives may be available.

Last Revised – 02/15/2017

What is cyclobenzaprine and What is Cyclobenzaprine side effects ?

What is cyclobenzaprine?

Cyclobenzaprine oral tablet is a prescription drug that’s available as the brand-name drug Fexmid.

It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Cyclobenzaprine also comes as an oral extended-release capsule.

Why it’s used

Cyclobenzaprine oral tablet is used to help relax muscles. It helps relieve pain, stiffness, or discomfort caused by strains or injuries to your muscles. It’s used along with rest and physical therapy. It should only be used for two to three weeks at a time.

Cyclobenzaprine may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Cyclobenzaprine belongs to a class of drugs called muscle relaxants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how this drug works to relax your muscles. It may decrease the signals from your brain that tell your muscles to spasm.

The primary adverse effects of cyclobenzaprine

The primary adverse effects of cyclobenzaprine include dizziness, xerostomia, drowsiness, fatigue, headache, nervousness, and confusion. Like other cyclical antidepressants, cyclobenzaprine antagonizes the muscarinic receptors, which may produce undesired side effects such as xerostomia, ileus, tachycardia, mydriasis, confusion, and hallucinations. Additionally, like other cyclical antidepressants, cyclobenzaprine antagonizes the alpha1 adrenergic receptor, causing a vasodilatory effect, and may contribute further to reflex tachycardia. The most common adverse effects seen with cyclobenzaprine are somnolence, dry mucous membranes, dizziness, and confusion

Cyclobenzaprine side effects

Cyclobenzaprine oral tablet may cause drowsiness and dizziness. This is more likely to happen in the few hours after you take it. It can also have other side effects.

More common side effects

The more common side effects of cyclobenzaprine can include:

- - dry mouth
  - dizziness
  - fatigue
  - constipation
  - drowsiness
  - nausea
  - heartburn

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

- Heart problems. Symptoms can include:
  - fainting
  - heart palpitations (fast or irregular heartbeat)
  - confusion
  - trouble speaking or understanding
  - loss of control or numbness in your face, arms, or legs
  - trouble seeing in one or both eyes
- Serotonin syndrome. Symptoms can include:
  - agitation (a feeling of aggravation or restlessness)
  - hallucinations (hearing or seeing something that isn’t there)
  - seizures
  - nausea

You can not take Prescription for a long time, you need find a way to treat your pain without prescription. Exercising is the best way to relieve your pain. because exercising can enhance your immune system and increase your muscle strength and make your nerve strong.

You can also take some natural nutritions to increase your immune system too.

Some anti-aging products can also increase your immune ability. You can try USANA Products to make you strong. I take USANA Essentials every day and I find my health get better and better.

Index Terms

Cyclobenzaprine HCl
Cyclobenzaprine Hydrochloride
Flexeril

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule Extended Release 24 Hour, Oral, as hydrochloride:

Amrix: 15 mg [contains fd&c red #40, fd&c yellow #10 (quinoline yellow)]

Amrix: 30 mg [contains brilliant blue fcf (fd&c blue #1), fd&c blue #2 (indigotine), fd&c red #40, fd&c yellow #6 (sunset yellow)]

Generic: 15 mg, 30 mg

Tablet, Oral, as hydrochloride:

Fexmid: 7.5 mg

Generic: 5 mg, 7.5 mg, 10 mg

Brand Names: U.S.

Amrix
Fexmid

Pharmacologic Category

Skeletal Muscle Relaxant

Pharmacology

Centrally-acting skeletal muscle relaxant pharmacologically related to tricyclic antidepressants; reduces tonic somatic motor activity influencing both alpha and gamma motor neurons

Metabolism

Hepatic via CYP3A4, 1A2, and 2D6; may undergo enterohepatic recirculation

Excretion

Urine (primarily as glucuronide metabolites); feces (as unchanged drug; Hucker, 1978); Clearance: 0.7 L/minute

Onset of Action

Immediate release: Within 1 hour

Time to Peak

Immediate release: ~4 hours (Winchell 2002); Extended release: 7 to 8 hours

Duration of Action

Immediate release: 12 to 24 hours

Half-Life Elimination

Normal hepatic function: Range: 8 to 37 hours; Immediate release: 18 hours; Extended release: 32 hours; Impaired hepatic function: 46.2 hours (range: 22.4 to 188 hours) (Winchell 2002)

Special Populations: Hepatic Function Impairment

In mild-to-moderate hepatic impairment, AUC and C_max increased approximately twofold with immediate-release cyclobenzaprine.

Special Populations: Elderly

AUC increased ~2.4-fold in elderly males and ~1.2-fold in elderly females with immediate-release cyclobenzaprine. AUC increased 40% and the plasma half-life is prolonged (50 hours) in elderly subjects with extended-release cyclobenzaprine.

Use: Labeled Indications

Muscle spasm: As an adjunct to rest and physical therapy for short-term (2 to 3 weeks) relief of muscle spasm associated with acute, painful musculoskeletal conditions.

Off Label Uses

Fibromyalgia

Data from multiple double-blind, placebo-controlled trials ^{[Bennett 1988]}, ^{[Quimby 1989]} support the use of cyclobenzaprine in the treatment of fibromyalgia.

Based on the European League Against Rheumatism revised recommendations for the management of fibromyalgia, cyclobenzaprine is recommended as an alternative agent in the management of this condition ^{[EULAR [Macfarlane 2017]]}.

Temporomandibular disorder, acute

Data from 2 randomized, double-blind, placebo-controlled trials of patients experiencing myofascial jaw pain upon awakening suggest that cyclobenzaprine at bedtime may have some benefit for the treatment of acute jaw pain due to temporomandibular disorder ^{[Alencar 2014]}, ^{[Herman 2002]}. Of note, 1 study demonstrated significant improvement in pain scores with treatment; however, no significant differences were seen compared to placebo ^{[Alencar 2014]}.

Contraindications

Hypersensitivity to cyclobenzaprine or any component of the formulation; during or within 14 days of MAO inhibitors; hyperthyroidism; heart failure; arrhythmias; heart block or conduction disturbances; acute recovery phase of MI

Dosing: Adult

Note: Patients more sensitive to sedating and other CNS adverse effects (eg, those who are older, debilitated patients, those with organ impairment) may better tolerate a reduced dose, less frequent administration, and/or more gradual titration (Chou 2019).

Fibromyalgia (alternative agent) (off-label use):

Note: For mild to moderate symptoms, particularly with sleep disturbance (EULAR [Macfarlane 2017]; Goldenberg 2020; Tofferi 2004).

Oral: Immediate release: Initial: 5 to 10 mg once daily before bedtime; may gradually titrate as needed and tolerated up to 10 to 40 mg daily in 1 to 3 divided doses (Calandre 2015; EULAR [Macfarlane 2017]; Goldenberg 2020; Tofferi 2004). If excessive sedation occurs, may divide dose so larger portion is taken at bedtime (eg, 5 mg in morning and 10 or 15 mg at bedtime) (Goldenberg 2020; Tofferi 2004).

Muscle spasm and/or musculoskeletal pain (adjunctive therapy):

Note: For skeletal muscle spasm and/or pain (eg, low back pain, neck pain) with muscle spasm, usually in combination with a nonsteroidal anti-inflammatory drug (NSAID) and/or acetaminophen (ACP [Chou 2017]; Borenstein 2003; van Tulder 2003). In general, muscle relaxants should be used temporarily (eg, for a few days or intermittently for a few days when needed) (APS 2016).

Oral: Immediate release: Initial: 5 mg 3 times daily scheduled or as needed with one of the doses administered at bedtime (Chou 2019). May increase dose based on response and tolerability up to 10 mg 3 times daily as needed. Once-daily use at bedtime (with daytime NSAID and/or acetaminophen) may be better tolerated (Knight 2020).

Oral: Extended release: Usual: 15 mg once daily; some patients may require up to 30 mg once daily.

Temporomandibular disorder, acute (adjunctive therapy) (off-label use):

Note: Adjunct to an NSAID in select patients with pain on palpation of the lower jaw muscle (Alencar 2014; Herman 2002; Mehta 2019).

Oral: Immediate release: Usual: 10 mg once daily at bedtime for 10 to 14 days (Alencar 2014; Herman 2002; Mehta 2019).

Dosing: Geriatric

Avoid use (Beers Criteria [AGS 2019]).

Dosing: Pediatric

Muscle spasm, treatment: Adolescents ?15 years: Oral: Immediate release tablet: Initial: 5 mg 3 times daily; may increase up to 10 mg 3 times daily if needed. Do not use longer than 2 to 3 weeks.

Administration

Oral: Extended release: Swallow whole and administer at the same time each day. Alternatively, the contents of the capsule may be sprinkled onto a tablespoon of applesauce and consume immediately without chewing; rinse mouth to ensure all contents have been swallowed; discard any unused portion of capsule.

Storage

Capsules: Store at 25°C (77°F); excursions are permitted to 15°C to 30°C (59°F to 86°F).

Tablets: Store between 20°C and 25°C (68°F and 77°F).

Drug Interactions

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy

Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Avoid combination

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Consider therapy modification

Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Botulinum Toxin-Containing Products: Muscle Relaxants (Centrally Acting) may enhance the adverse/toxic effect of Botulinum Toxin-Containing Products. Specifically, the risk for increased muscle weakness may be enhanced. Monitor therapy

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Consider therapy modification

Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination

CloZAPine: Anticholinergic Agents may enhance the constipating effect of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Consider therapy modification

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Consider therapy modification

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Consider therapy modification

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Monitor therapy

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination

Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Consider therapy modification

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination

Lisuride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Monitor therapy

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Consider therapy modification

Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy

Monoamine Oxidase Inhibitors: Cyclobenzaprine may enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome. Avoid combination

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Monitor therapy

Ombitasvir, Paritaprevir, and Ritonavir: May decrease the serum concentration of Cyclobenzaprine. Monitor therapy

Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir: May decrease the serum concentration of Cyclobenzaprine. Monitor therapy

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification

Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Monitor therapy

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination

Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Avoid combination

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Avoid combination

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy

Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Avoid combination

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Consider therapy modification

Serotonergic Agents (High Risk): Cyclobenzaprine may enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Exceptions: Isocarboxazid; Linezolid; Methylene Blue; Moclobemide; Phenelzine; Tranylcypromine. Monitor therapy

Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Consider therapy modification

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination

Tolperisone: May enhance the adverse/toxic effect of Muscle Relaxants (Centrally Acting). Management: Monitor for increased sedation or CNS effects if tolperisone is combined with other centrally acting muscle relaxants. Consider decreasing the tolperisone dose if these agents are combined. Consider therapy modification

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification

Test Interactions

May cause false-positive serum TCA screen (Wong, 1995)

Adverse Reactions

>10%:

Central nervous system: Drowsiness (1% to 39%), dizziness (1% to 11%)

Gastrointestinal: Xerostomia (6% to 32%)

1% to 10%:

Central nervous system: Fatigue (1% to 6%), headache (1% to 5%), confusion (1% to 3%), decreased mental acuity (1% to 3%), irritability (1% to 3%), nervousness (1% to 3%)

Gastrointestinal: Dyspepsia (?4%), abdominal pain (1% to 3%), acid regurgitation (1% to 3%), constipation (1% to 3%), diarrhea (1% to 3%), nausea (1% to 3%), unpleasant taste (1% to 3%)

Neuromuscular & skeletal: Weakness (1% to 3%)

Ophthalmic: Blurred vision (1% to 3%)

Respiratory: Pharyngitis (1% to 3%), upper respiratory tract infection (1% to 3%)

<1%, postmarketing, and/or case reports: Abnormal dreams, abnormal hepatic function tests, abnormality in thinking, ageusia, agitation, anaphylaxis, angioedema, anorexia, anxiety, ataxia, cardiac arrhythmia, cholestasis, convulsions, depression, diaphoresis, diplopia, disorientation, dysarthria, excitement (paradoxical, children), facial edema, flatulence, gastritis, gastrointestinal pain, hallucination, hepatitis (rare), hypertonia, hypotension, increased thirst, insomnia, jaundice, malaise, muscle twitching, palpitations, paresthesia, pruritus, psychosis, seizure, serotonin syndrome, skin rash, syncope, tachycardia, tinnitus, tongue edema, tremor, urinary frequency, urinary retention, urticaria, vasodilation, vertigo, vomiting

Warnings/Precautions

Concerns related to adverse effects:

• Anticholinergic effects: Use with caution in patients with angle-closure glaucoma, increased intraocular pressure, or urinary frequency/hesitancy.

• CNS depression: May cause CNS depression, which may impair physical or mental abilities; ethanol and/or other CNS depressants may enhance these effects. Patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

• Serotonin syndrome: Potentially life-threatening serotonin syndrome has occurred with cyclobenzaprine when used in combination with other serotonergic agents (eg, SSRIs, SNRIs, TCAs, buspirone, meperidine, tramadol, MAO inhibitors), bupropion, and verapamil. Monitor patients closely especially during initiation/dose titration for signs/symptoms of serotonin syndrome such as mental status changes (eg, agitation, hallucinations); autonomic instability (eg, tachycardia, labile blood pressure, diaphoresis); neuromuscular changes (eg, tremor, rigidity, myoclonus); GI symptoms (eg, nausea, vomiting, diarrhea); and/or seizures. Discontinue cyclobenzaprine and any concomitant serotonergic agent immediately if signs/symptoms arise. Concomitant use or use within 14 days of discontinuing an MAO inhibitor is contraindicated.

• Toxicity: Cyclobenzaprine shares the toxic potentials of the tricyclic antidepressants, including prolongation of conduction time, arrhythmias, and tachycardia; the usual precautions of tricyclic antidepressant therapy should be observed.

Disease-related concerns:

• Hepatic impairment: Use with caution in patients with mild hepatic impairment; plasma concentrations increased twofold in presence of mild impairment. Not recommended in moderate-to-severe hepatic impairment. Extended release capsules not recommended in patients with hepatic impairment of any severity (mild, moderate, or severe).

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Elderly: Extended release capsules not recommended for use in elderly.

Other warnings/precautions:

• Appropriate use: Limit therapy to 2-3 weeks; efficacy has not been established for longer periods of use.

Pregnancy Considerations

Published information related to cyclobenzaprine use in pregnancy is limited (Flannery 1989; Moreira 2014).

Patient Education

What is this drug used for?

• It is used to relax muscles.

Frequently reported side effects of this drug

• Fatigue

• Dizziness

• Loss of strength and energy

• Dry mouth

• Constipation

• Nausea

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Fast heartbeat

• Abnormal heartbeat

• Serotonin syndrome like dizziness, severe headache, agitation, sensing things that seem real but are not, fast heartbeat, abnormal heartbeat, flushing, tremors, sweating a lot, change in balance, severe nausea, or severe diarrhea.

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Robaxin Drug Interaction

Most frequently checked interactions

View interaction reports for Robaxin (methocarbamol) and the medicines listed below.

- Advil (ibuprofen)
- Aleve (naproxen)
- Ambien (zolpidem)
- Benadryl (diphenhydramine)
- codeine
- Cymbalta (duloxetine)
- Flexeril (cyclobenzaprine)
- gabapentin
- gabapentin
- hydrocodone
- ibuprofen
- ibuprofen
- Klonopin (clonazepam)
- lisinopril
- Lyrica (pregabalin)
- metformin
- Motrin (ibuprofen)
- naproxen
- Neurontin (gabapentin)
- Norco (acetaminophen / hydrocodone)
- omeprazole
- oxycodone
- oxycodone
- prednisone
- Synthroid (levothyroxine)
- tramadol
- tramadol
- trazodone
- Tylenol (acetaminophen)
- Valium (diazepam)
- Vicodin (acetaminophen / hydrocodone)
- Vitamin D3 (cholecalciferol)
- Xanax (alprazolam)
- Zoloft (sertraline)
- Zyrtec (cetirizine)