Flexeril was one popular brand name for the drug cyclobenzaprine. Although the brand Flexeril is no longer available, many doctors still use its name to refer to cyclobenzaprine. Cyclobenzaprine likely treats fibromyalgia by increasing the effects of norepinephrine, a substance in your brain and spinal cord that helps reduce pain signals. Zanaflex is the brand name for the drug tizanidine. Substance P is a chemical that helps increase pain signals to and from the brain.
Drinking alcohol with either drug may cause severe drowsiness and make you much less alert. This effect can make activities such as driving difficult and unsafe. Doing so may cause withdrawal symptoms. If you need to stop taking either drug, talk to your doctor. They may slowly lower your dosage over time.
Although not common, in some cases tizanidine and cyclobenzaprine have been misused or abused. Be sure to take either drug exactly as your doctor tells you to. If you have questions or concerns, talk with your doctor.
Generally, the brand-name drugs are more expensive than the generics. Between the generics, tizanidine may be slightly more expensive than cyclobenzaprine. Both drugs are available in most pharmacies. Health insurance plans usually cover the generic forms of both drugs without prior authorization. In many cases, insurance companies will require a prior authorization for Zanaflex or Amrix a current brand name for extended-release cyclobenzaprine. Tizanidine and cyclobenzaprine cause similar side effects.
The chart below compares examples of side effects of both drugs. In rare cases, liver problems from these drugs may cause hepatitis inflammation of your liver and jaundice yellowing of your skin and whites of eyes. Additionally, cyclobenzaprine can cause:. For instance, both drugs interact with central nervous system CNS depressants like alcohol, narcotics, and benzodiazepines. Taking either tizanidine or cyclobenzaprine with a CNS depressant can cause intense drowsiness.
Both tizanidine and cyclobenzaprine can cause problems if you take them when you have certain other health issues. In one open-label study 20 patients , the addition of cyclobenzaprine to naproxen Naprosyn resulted in a statistically significant decrease in muscle spasm and tenderness compared with naproxen alone.
Cyclobenzaprine has also been studied in treating fibromyalgia. A meta-analysis of five trials ranging from six to 24 weeks' duration included a total of patients with fibromyalgia. The authors reported that, although cyclobenzaprine moderately improved sleep and pain, the long-term benefits were unknown.
This meta-analysis was limited by a high drop-out rate, short trial duration, few studies having an intention-to-treat design, and inadequate blinding. Strong data comparing skeletal muscle relaxants to each other are scarce. A systematic review evaluated 46 trials head-to-head and placebo-controlled comprising mostly of studies on low back pain or neck syndromes.
The placebo-controlled trials included 17 on cyclobenzaprine, six on tizanidine, four on carisoprodol, and four on orphenadrine, and were mostly conducted more than 15 years ago. The average patient enrollment was less than patients range 12 to patients. In general, all of the drugs were shown to have some benefit. One fair-quality study showed carisoprodol was better than diazepam at improving muscle spasm and global and functional status in patients with low back pain. A different systematic review did include some studies which were considered to be high quality.
Although the evidence for effectiveness of skeletal muscle relaxants in musculoskeletal conditions is limited, strong evidence does exist in terms of toxicity. Selection of a skeletal muscle relaxant should be individualized to the patient. If there are tender spots over the muscle or trigger points on physical examination, a skeletal muscle relaxant is a reasonable adjunct to analgesic treatment of low back pain.
Skeletal muscle relaxants may also be used as an alternative to NSAIDs in patients who are at risk of gastrointestinal or renal complications. Patients with low back pain or fibromyalgia may benefit from treatment with cyclobenzaprine. Recent evidence showed similar effectiveness at half of its manufacturer recommended dose 5 mg , but with fewer adverse effects.
Higher doses of cyclobenzaprine or tizanidine would be appropriate to promote sedation in cases of more severe discomfort or perceived muscular spasm. Although there appears to be insufficient data on metaxalone and methocarbamol, these may be useful in patients who cannot tolerate the sedative properties of cyclobenzaprine or tizanidine.
Of note, methocarbamol costs substantially less than metaxalone. Carisoprodol is metabolized to meprobamate a class III controlled substance and has been shown to produce psychological and physical dependence. Although all skeletal muscle relaxants should be used with caution in older patients, diazepam especially should be avoided in older patients or in patients with significant cognitive or hepatic impairment.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. She received her doctor of pharmacy degree from Rutgers University College of Pharmacy in New Brunswick, NJ, and completed an inpatient family medicine pharmacy specialty residency at Deaconess Hospital and the St.
Louis College of Pharmacy in St. Louis, Mo. She received her doctor of pharmacy degree from St. Reprints are not available from the authors. Carisoprodol carisoprodol tablet [package insert]. Philadelphia, Pa. Accessed January 14, Chlorzoxazone chlorzoxazone tablet [package insert]. Sellersville, Pa. Cyclobenzaprine hydrochloride cyclobenzaprine hydrochloride tablet [package insert].
Corona, Calif. Diazepam diazepam tablet [package insert]. Miami, Fla. Skelaxin metaxalone [package insert]. Briston, Tenn. Methocarbamol methocarbamol tablet [package insert]. January 14, Orphenadrine citrate extended-release orphenadrine citrate tablet [package insert]. Princeton, NJ: Sandoz, Inc. Tizanidine hydrochloride tizanidine hydrochloride tablet [package insert].
Pomona, NY: Barr Laboratories. United States Food and Drug Administration. Zanaflex tizanidine hydrochloride tablets and capsules. Top brand-name drugs by units in Top generic drugs by units in Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society [published correction appears in Ann Intern Med. Ann Intern Med. National Headache Foundation. National Headache Foundation standards of care for headache diagnosis and treatment.
Chicago, Ill. Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. Prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants for back pain in the United States. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review.
J Pain Symptom Manage. Diamond S. Double-blind study of metaxalone; use as a skeletal-muscle relaxant. Tizanidine was shown to be effective for spasticity due to multiple sclerosis.
Both cyclobenzaprine and tizanidine were found to be effective for musculoskeletal conditions such as acute neck or back pain.
The meta-analysis assessed over different trials comparing several muscle relaxants, including Lioresal baclofen , Soma carisoprodol , Robaxin methocarbamol , Skelaxin metaxalone , and Valium diazepam. Overall, the study found that these drugs are comparable in efficacy and safety. Other guidelines suggest that muscle relaxants cause increased drowsiness and should only be used short-term.
Drugs like Zanaflex and Flexeril are often recommended along with physical therapy to relieve pain. Consult a healthcare provider to determine the best treatment option for you.
Generic Zanaflex is typically covered by most Medicare and insurance plans. Immediate-release tablets are commonly prescribed to be taken multiple times per day. Get a prescription coupon. The most common side effects of Zanaflex include dry mouth, drowsiness, dizziness, muscle weakness or fatigue, and constipation. Other reported side effects include urinary tract infections UTIs and involuntary movements dyskinesia.
The most common side effects of Flexeril include drowsiness, dry mouth, headache, fatigue, and dizziness. Flexeril is also known to cause other side effects such as constipation and nausea. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more. Zanaflex is mainly processed by the CYP1A2 enzyme in the liver. Drugs that block, or inhibit, this enzyme can increase Zanaflex levels in the body. Increased drug levels can lead to increased adverse effects such as drowsiness and dizziness.
Zanaflex should be avoided with CYP1A2 inhibitors like ciprofloxacin and cimetidine as well as birth control pills containing ethinyl estradiol. Flexeril can interact with serotonergic drugs like antidepressants and MAO inhibitors.
Taking these drugs with Flexeril can increase the risk of serotonin syndrome, a condition that requires immediate medical attention. These types of drugs include barbiturates, opioids, and benzodiazepines. Zanaflex and Flexeril can enhance their effects and lead to increased dizziness and sedation. Zanaflex has the potential to cause hypotension or abnormally low blood pressure. This effect typically manifests as orthostatic hypotension which occurs when a person moves to an upright position after lying down.
In excess doses, Flexeril is also known to cause changes in blood pressure. Zanaflex may cause liver injury in some people, especially those who have a history of liver impairment. Flexeril should also be used with caution in individuals with liver problems. Flexeril is known to cause serotonin syndrome , especially when taken with certain antidepressants, MAO inhibitors, and opioids. Signs and symptoms of serotonin syndrome should be monitored when starting treatment with Flexeril.
Zanaflex, or tizanidine, is a muscle relaxant used to treat muscle spasticity due to multiple sclerosis and spinal cord injury.
It works by blocking signals between motor nerves to relax muscle tone. It is usually taken as a 2 mg or 4 mg tablet every six to eight hours. Flexeril is the brand name for cyclobenzaprine. It is a muscle relaxant indicated for acute, painful musculoskeletal conditions such as neck or back pain. It works in the central nervous system CNS to relieve muscle pain and spasms.
Cyclobenzaprine is available in immediate-release and extended-release forms.
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