Prescription Muscle Relaxers
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Muscle Relaxers - An Important Category
Muscle relaxers, AKA "skeletal muscle relaxants", make up an important category of prescription medication useful for the relief of muscle pain and muscle spasm. Muscle relaxers are not available without a prescription in the U.S. For those who must bear the challenges of chronic pain, multiple sclerosis, or spinal injury, prescription muscle relaxers are often the medications which allow them to enjoy a reasonable quality of life. They are often used for short term relief of back or neck spasm or stiffness. Sometimes finding the appropriate prescription muscle relaxer can be challenging. As with many medications, what works well for one person may not work well for another.
In this article I intend to list and discuss briefly all of the currently available prescription muscle relaxers. I will provide you with the appropriate adult dosages, side-effects, and any relevant links to more helpful information. Hopefully this will provide you with the resource you need to discuss prescription muscle relaxers with your doctor. For convenience I have arranged them alphabetically by their generic name, and I will list the currently available brand names underneath. Note: although every drug has a "generic name" this does not mean or imply that it has a generic "available".
BACLOFEN
Brand Name(s): Lioresal (Brand name is not currently available, but the generic is still available)
Generic Available? Yes
Adult Dosage: 10mg - 20mg given three to four times daily.
Side Effects: Drowsiness, confusion, dizziness and fatigue. Seizures and hallucinations have been observed with overdosage or abrupt discontinuation of therapy.
Discussion: Originally approved by the FDA in 1977. Interestingly, baclofen has also been studied for its benefits to assist in supressing alcohol addiction.
For More Information:
CARISOPRODOL
Brand Name(s): Soma, Soma Compound (carisoprodol + aspirin), Soma compound with codeine (carisoprodol, aspirin, and codeine)
Generic Available? YES (except for Soma 250mg)
Adult Dosage: 250mg - 350mg three times daily and at bedtime
Side Effects: Drowsiness and dizziness.
Discussion: This prescription muscle relaxer was approved by the FDA back in 1959, carisoprodol has been used for decades for treating muscle spasm and stiffness. One of the metabolites of carisoprodol is a drug called "meprobamate" which is a controlled substance indicated for anxiety (though rarely used today). Some reports of dependance and withdrawl have been noted, and may be due to this metabolite. The combination with aspirin and/or codeine is used to treat pain as well as spasm. Do not use if allergic to aspirin or codeine.
For more information:
CHLORZOXAZONE
Brand Names(s): Parafon Forte DSC
Generic Available? Yes
Adult Dosage: 250mg - 750mg three to four times daily. Use with extreme caution in the elderly.
Side Effects: Drowsiness and dizziness. Stop immediately if a skin rash developes. Do not use if there is a history of liver or kidney disease. Do not use with alcohol.
Discussion: Approved by the FDA in 1987. Mechanism of action is not fully understood, but may be due, at least in part, to the sedative properties it possesses.
For more information:
CLICK HERE FOR FULL PRESCRIBING INFORMATION ON PARAFON FORTE DSC
CYCLOBENZAPRINE
Brand Name(s): Flexeril, Flexmid, Amrix
Generic Available? Yes, but not for Flexmid or Amrix
Adult Dosage: 5-10mg three times daily. Amrix is an extended release formulation dosed once daily (it comes in 15mg & 30mg capsules).
Side Effects: Drowsiness, dizziness and dry mouth. It should generally not be taken with tricyclic antidepressants (eg Elavil), MAO inhibitors (eg Parnate), other drugs that effect the heart rhythm nor mixed with alcohol.
Discussion: First approved by the FDA in 1977. Very widely used and prescribed. Dosages above 30mg per day are not recommended.
For more information:
- Flexeril Prescribing Information
- Amrix Prescribing Information
- Flexmid Prescribing Information
- FREE Amrix sample coupons
DANTROLENE
Brand Name(s): Dantrium
Generic Available: Yes
Adult Dosage: Start with 25mg once daily. Slowly titrate upwards, may increase to a maximum of 100mg four times daily.
Side Effects: Drowsiness, dizziness, weakness, diarrhea, difficulty swallowing and nausea. Liver toxicity has occured at higher dosages.
Discussion: Approved by the FDA in 1974. Dantrium works differently than most other muscle relaxants. It acts directly upon the muscle cells by interfering with the movement of Calcium ions and thereby relaxing the muscle.
For More Information:
Skelaxin
METAXALONE
Brand Name: Skelaxin 800mg
Generic Availble? No
Adult Dosage: 800mg three to four times daily. Maximum daily dose is 3200mg.
Side Effects: Nausea, vomiting, drowsiness, dizziness, headache, and anxiety.
Discussion: Originally approved by the FDA in 1962. Most of the effectiveness of Skelaxin is likely due to its sedative properties.
For More Information:
METHOCARBAMOL
Brand Name(s): Robaxin
Generic Available? Yes
Adult Dosage: 1.5 Grams (3 500mg tablets) four times daily without regard to meals. May increase up to 2 grams (4 tablets) four times daily when appropriate.
Side Effects: Drowsiness, dizziness, blurred vision, headache, fever and nausea.
Discussion: Originally approved by the FDA in 1957. Interestingly methocarbamal is structurally similar to the over-the-counter mucus reducer known as Guaifenesin, and guaifenesin is one of its metabolites. Sorry, that doesn't mean that Mucinex can be used as a muscle relaxant.
For More Information:
Norflex
ORPHENADRINE
Brand Name(s): Norflex
Generic Available? Yes
Adult Dosage: 100mg twice daily (morning and evening)
Side Effects: Dry mouth, blurry vision, constipation, drowsiness, headache and nausea.
Discussion: Initial FDA approval was in 1959. It is structurally similar to the antihistamine "diphenhydramine" (AKA Benadryl)! Sorry, it won't help with your sneezing though.
For More Information:
Zanaflex Capsule
TIZANADINE
Brand Name(s): Zanaflex
Generic Available? Yes, but only the tablets. The Zanaflex capsules (2mg, 4mg and 6mg) are not available generically.
Adult Dosage: 2mg to 4mg every 6 to 8 hours (maximum of 3 doses daily). Maximum daily dosage is 24mg.
Side Effects: Weakness, drowsiness, dry mouth, and dizziness.
Discussion: Approved by the FDA in 1996. Tizanadine has a rapid onset of action, within 1-2 hours, and the effect begins to taper off after about 6 hours. Avoid using while taking the antibiotic Cipro or the antidpressant medication fluvoxamine. The capsules can be opened and sprinkled on soft food for easier swallowing if necessary.
For More Information:
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Comments
I remember some talk about that back in 1999. At that point I believe Merck still owned the rights to Flexeril. They sold it off to ALZA who was acquired by Johnson and Johnson and it is now distributed by McNeil...
Follow all that??? Its crazy. Once a drug goes off patent it is like a game of hot potato. This also suggests that it is unlikely to hit the OTC market, probably due to safetly issues related to potential overdose, etc.
Thanks for the question!!!
I found this page while googling about trying to figure out if Benadryl was somehow related to muscle relaxation. I took benadryl-d for sinus blockage and when I woke up, the muscle pain I've had in my upper back for a couple of years was gone! This article states that it is structurally similar to Norflex. At least I know I'm not imagining things! Since I can't take a decongestant long term, I've started taking 2 regular benadryls at bedtime. With this, I feel great in the morning, but can feel my muscles starting to tighten up and burn by evening. Is there any problem with doing this long term?
Hi Paula,
Glad to be of some help. Taking Benadryl long-term is fine. Of course, the bigger question is about the cause of the pain and if this pain has been evaluated by a physician. If so, and Benadryl helps, then an adult can safely take the recommended dose every day (assuming you have no other medical conditions for which Benadryl would be contraindicated).
Sincerely,
Jason
Are there any muscle relaxants that DO NOT induce, affect, inhibit
liver function, Cytochrome p450, enzyme CYP2C19, etc., etc.?
If so, what are the names of these muscle relaxant medications?
If not, are there any muscle relaxants that affect the liver the least?
I prefer taking a muscle relaxant that does not affect the liver at all
or at most very minimally.
Thanks!
Hi Art,
Baclofen is metabolized by the liver to a much lesser degree than many of the other muscle relaxants (about 15% of the baclofen dose is metabolized by the liver). The rest is excreted in the urine unchanged.
Best wishes,
Jason
Hi Jason,
Thanks for letting me know about the Baclofen.
I take Soma for muscle spasms. It works fine but I'm concerned that it
might possibly affect my liver, especially long-term. I'm a cautious medication
user. I'm supposed to take it every day but would rather not if I can help it.
In your professional opinion, if one has take a muscle relaxant on a regular basis
for a chronic pain/muscle condition would you say that Baclofen is the "safest" one
of all? There are so many muscle relaxants out there to choose from. I only want
the safest one or none at all.
Art,
Good questions. The "safety" depends somewhat upon your own medical history and condition, which your doctor is in the best position to evaluate. Liver function can be easily monitored, and if concerns arise, medication can be changed. When used appropriately in moderate doses under medical supervision, Soma is very safe. There are studies which raise concerns about dependance with Soma. This is a separate issue. Baclofen is not necessarily safer, just less metabolized by the liver.
Get several opinions from trusted doctors, especially if this is going to be a long term treatment.
Best wishes,
Jason
Hi Jason,
thanks for this article I found it while trying to find out about muscle relaxing meds that may be less hard on the liver. I was diagnosed with N.A.S.H just over a year and a half ago with some fibrosis but it is very little and have ( through a combo of meds, diet and exercise ) been able to get my Liver levels closer to " normal".
Though the exercise is limited due to neck/shoulder/back pain , I have nerve root compression at or near about C-5 anyway my pain is ...well bearable with the meds I'm taking as well as therapy but I had been having a lot of trouble sleeping and it was mostly due to the pain...well my pain dr gave me Zanaflex 4 mg take 3xs daily as needed for extra pain relief and the nurse said it could be taken with or without food, but if I took without food it would increase drowsiness and help me sleep well not knowing exactly how it would effect me personally I took with food the first night about 30 min before bedtime and I sleep the whole night didn't wake up once and I felt incredible, so I thought boy we must be on to something :) well about 4 days later ( and I was only taking w/ food and at bedtime because if I am that sleepy w/ food couldn't imagine w/o, anyway I started feeling nauseated and vomitted and was weak and eventually got to sleep and didn't take the Zanaflex the following couple of nights just in case but a friend became sick in those few days so I assumed it was something going around and resumed taking it as I had been, only a few days later I'd say 4 or 5 I took it and went to bed and had chills/cold sweats and then with the chills I'd cover up but that was way to hot and it was kinda scary I felt really weak and it was difficult not to panic , but after I lay there a bit I was able to get up and go in the other room where my mother was sleeping and woke her telling her what was going on and so then I got settled and slept the rest of the night but I've been quite nervous about taking it again. It works like it should best I've tried, however I don't know if it's an allergy or perhaps the levls are building ,almost like my liver isn't processing it well enough and almost too much med. Anyway not trying to ramble all night, but have you heard of anything like that? Could it build up because of my liver issues? thanks so much for the article and also for your time ( yes I've tried calling my pain dr but he's away on vacation :)
Hi CC,
Sorry about your experience. Sadly I cannot give specific medical advice as to your condition and therapy with Zanaflex. Your symptoms, of course, could be due to many things. The medication can cause the symptoms you describe. And with your condition it is advisable to keep a close eye on liver function. Your doctor may suggest a smaller dose, or an alternative therapy. Let him/her make that decision with you. If your doctor is away, use the on-call service or your general practitioner as a medical resource.
A local pharmacist may also be in a good position to offer some help. For those with no such access, I have at times suggested my own services, which I advertise here:
http://managemymeds.weebly.com/index.html
But hopefully with the help of your doctor and local professionals you will find a treatment that works for you.
Blessings,
Jason
Jason, thank you so much for the advice knowing that the meds CAN cause the symptoms is enough info for now, I'm going to hold off on it until I can talk with my dr. Thanks so much again I realize you can't comment specifically, no problem. I was wondering if the symptoms COULD be caused, I have been all over the internet and you are the first "light" to shine upon the issue. I'm bookmarking that link however in case I or someone I know may need it in the future. Also thanks for such a speedy reply.
Blessings to you
> CC
hi, can anyone tell me if there is a muscle relaxer that works like soma? Ive been on soma for 6 months and it works great, but now my insurance wont pay for soma. I am trying to find one that is equivelant to soma. If anyone can please help me with this question? Thank You, Lynn
Hi Lynn,
Soma is available generically as carisoprodol. Most plans cover this, and if not, it is relatively innexpensive. Is it the brand name you have been taking? If so, try the generic. Otherwise, generic Flexeril is often a good alternative. Soma is somewhat unique. No other muscle relaxer has exactly the same properties. Hope that helps.
-Jason
For two years i have been suffering from right shoulder pains. Can't barely do heavy work or lift my right arm not even at 90 degree angle. My back been hurting. There are times I can't get up from the bed cause it feels like my back is about to give out. Various time xrays were taken and doctors don't find anything. Yet the pain are worse. Therapy made my right shoulder worse. I was prescribed muscle relaxer to take three times a day with meals. Guess what? It didn't help? What do I do now?
Sandy,
I am so very sorry for your pain and the lack of success so far in treating it. As a pharmacist, the best advice I can give you right now is to seek more opinions from different doctors who specialize in that type of pain. I know it seems hopeless. But I have had many, many patients share with me that they "finally found someone who knew what was wrong."
Also, there are always new Muscle relaxants and pain relievers coming out. Find a doctor who is willing to try different ones. Keep a journal and record the results carefully. Also keep a daily pain journal. Finally, on days that the pain is not so bad, find some "visible" way to record this day on your calender. It will encourage you when you have a stretch of bad days.
Sincerely,
Jason
I also found this site through google as I was searching for the best prescription muscle relaxer. I have gone trhough few, mainly including the 10mg flexeril and it didn't help much with neck and back pains as well as headaches.
I would like to know the best of the best muscle relaxer, and then the best choice in my position of associated muscle problems. Thank you very much
Hi Alex,
It is a good question you ask. But a hard one. The simple answer is: the best muscle relaxer is the one that works for you. Unfortunately...that just takes some time to try them. Typically Flexeril, which you tried, is the best to start with. How one person responds does not necessarily indicate how someone else will. So when friends and family say things like "this one works...but that one doesn't" you have to take such advice with a grain of salt.
Hope you find the "best" one soon!!
Sincerely,
Jason
imadork says:
10 months ago
I think I remember hearing awhile ago that Flexeril 5mg was going to be released OTC. What happened with that?