Diazepam Valium 4. Adults: 2 to 10 mg three to four times daily Children: 0. Dizziness, drowsiness, confusion Abuse potential.
Long elimination half-life; avoid in older patients and in patients with hepatic impairment. Metaxalone Skelaxin 5. Drowsiness, dizziness, headache, nervousness Leukopenia or hemolytic anemia rare Liver function test elevation rare Nausea, vomiting, and diarrhea rare Paradoxical muscle cramps.
Use with caution in patients with liver failure Possible respiratory depression when combined with benzodiazepines, barbiturates, codeine or its derivatives, or other muscle relaxants Less dizziness and drowsiness than other skeletal muscle relaxants FDA pregnancy category C.
Methocarbamol Robaxin 6. Black, brown, or green urine possible Mental status impairment Possible exacerbation of myasthenia gravis symptoms. Possible respiratory depression when combined with benzodiazepines, barbiturates, codeine or its derivatives, or other muscle relaxants FDA pregnancy category C; reports of fetal abnormalities.
Orphenadrine Norflex 7. Anticholinergic effect drowsiness, dry mouth, urinary retention, increased intraocular pressure Aplastic anemia rare GI irritation Confusion, tachycardia, hypersensitivity reaction with high doses.
Decreases effect of phenothiazines e. Tizanidine Zanaflex 8 , 9. Dose-related hypotension, sedation, and dry mouth Hepatotoxicity; monitor liver function tests at baseline and one, three, and six months Withdrawal and rebound hypertension may occur in patients discontinuing therapy after receiving high doses for long period of time; tapering is recommended.
All of these drugs may cause increased drowsiness with central nervous system depressants. Caution is advised when prescribing skeletal muscle relaxants in older patients. Estimated cost to the pharmacist based on average wholesale prices rounded to the nearest dollar in Red Book. Montvale, N. Cost to the patient will be higher, depending on prescription filling fee. Information from references 1 through 9.
Among antispasmodic agents, carisoprodol Soma , cyclobenzaprine Flexeril , metaxalone Skelaxin , and methocarbamol Robaxin were among the top drugs dispensed in the United States in The American Pain Society and the American College of Physicians recommend using acetaminophen and nonsteroidal anti-inflammatory drugs NSAIDs as first-line agents for acute low back pain and reserving skeletal muscle relaxants as an alternative treatment option. Similar recommendations exist in treating tension headaches.
Prescription rates for nonspecific back pain revealed that skeletal muscle relaxants accounted for This article presents evidence regarding the use of antispasmodic skeletal muscle relaxants for various musculoskeletal conditions, and appropriate drug selection if a skeletal muscle relaxant is required.
Highlights of contraindications, adverse effects, and drug interactions for these drugs are listed in Table 1. Many of the studies evaluating the effectiveness of skeletal muscle relaxants are hampered by poor methodologic design, including incomplete reporting of compliance, improper or no mention of allocation concealment, not utilizing intention-to-treat methods, and inadequate randomization. Some evidence appears to support nonbenzodiazepine skeletal muscle relaxants, such as carisoprodol, cyclobenzaprine, orphenadrine Norflex , and tizanidine Zanaflex , for acute low back pain.
One fair-quality study showed no difference between metaxalone and placebo. Cyclobenzaprine has been the most heavily studied drug, with consistently proven effectiveness.
Cyclobenzaprine was found to be moderately more effective than placebo, but had more central nervous system adverse effects. The authors also described several limitations of the meta-analysis including inadequate blinding, heterogeneity among studies, and the presence of publication bias.
Skeletal muscle relaxants have also been studied as adjunctive therapy to analgesics in treating acute low back pain. 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, Although Skelaxin and Flexeril are both in the same drug category skeletal muscle relaxants , they do have some differences, such as side effects, dose, and pricing, as outlined above. No data directly compares the two drugs in terms of pain relief. Therefore, if you need a muscle relaxant, your healthcare provider will consider your symptoms, conditions, and any medications you take that could interact with Skelaxin or Flexeril to determine if one of these drugs is better for you.
Safe use of metaxalone has not been established with regard to possible adverse effects upon fetal development. The Flexeril manufacturer information states that there are no adequate, well-controlled studies in pregnant women. Therefore, Flexeril should be used in pregnant women only if clearly needed. Using Skelaxin or Flexeril with alcohol can increase the side effects such as dizziness and drowsiness.
It can also lead to impaired coordination, which can cause accidents. Also, taking a muscle relaxant with alcohol can increase the chance of abuse or dependence. Consult your healthcare provider for more information.
Yes, Skelaxin helps with the pain of acute muscle spasms. The manufacturer recommends using Skelaxin along with rest, physical therapy, and other measures. The way it works is not entirely understood but is likely due to central nervous system depression. Skelaxin does not directly work on the muscles or nerves.
Like any medication, Skelaxin has benefits as well as side effects and risks. See the Warnings section above for more information. If your healthcare provider has determined that Skelaxin is appropriate for you and is compatible with any medical conditions you have and medications you take, you will likely be able to safely take Skelaxin for short-term use with no significant issues.
Consult your healthcare provider for medical advice. Skip to main content Search for a topic or drug. Skelaxin vs. Flexeril: Differences, similarities, and which is better for you. By Karen Berger, Pharm. Top Reads in Drug vs. Toujeo vs Lantus: Main Differences and S While there are many ways to treat and manage pain, many doctors prescribe muscle relaxers as an initial solution.
First, treatment may consist of over-the-counter medication like paracetamol or acetaminophen. Next, come the anti-steroidal non-steroidal anti-inflammatory drugs like ibuprofen and naproxen sodium.
After these two, the doctor may prescribe a muscle relaxant instead. Often, these are given to sufferers of acute pain.
Despite their name, muscle relaxants do not work on the muscles, but rather on the brain. These drugs feature drowsiness as a welcome side effect. This helps patients get into a state of rest or sleep easier. Doctors prescribe muscle relaxants for a few days or a couple of weeks until the acute pain disappears. However, if the pain is described as chronic, a longer prescription may be necessary.
Doctors weigh the benefits versus the risks of each prescription on a case to case basis. Individual histories listing allergic reactions, seizures, liver issues, pregnancy or breastfeeding status for women are taken into consideration before a licensed practitioner can issue a prescription.
When in doubt, always seek the opinion of a medical professional. Below are five of the more common muscle relaxants often prescribed by doctors to alleviate pain. Be mindful when taking these prescription medicines. Muscle relaxers often provide a sedative effect that will impede daily activities such as operating machinery or exercise. Never take them without getting clearance from a doctor. Carisoprodol helps alleviate musculoskeletal pain.
While its potency usually sets within 30 minutes, its effectiveness is only known to last up to three weeks.
Side effects include sleepiness, headaches, dizziness, seizures and allergic reactions. As mentioned earlier, carisoprodol is also highly addictive and is often used in conjunction with opioids. Sold under the brand name Soma, this drug has already been banned for use in Europe since but is still actively prescribed in the US. A medication used since the late s, cyclobenzaprine helps treat muscle spasms that suddenly arise.
The drug reduces pain in the first few days and works for up to two weeks. Afterward, it stops becoming effective. Common side effects include headache, fatigue, dizziness, and dry mouth. It can also cause irregular heartbeats. The sedative effects of cyclobenzaprine are very well known, so taking it during the daytime poses some risks. Part of the benzodiazepine groups of drugs, diazepam is known for its calming effect. Despite acting more as a sedative rather than as a muscle relaxant, diazepam is a popular prescription to address muscle pain.
It is a drug that can be taken orally, anally, injected in veins or muscles directly, or used as a nasal spray. It also is habit-forming and is often abused in combination with narcotics, alcohol, or other drugs. Side effects include drowsiness and coordination issues.
On rare occasions, the drug can trigger seizures and cause breathing troubles. Use of diazepam is also known to increase the incidences of self-harm and suicide. Metaxalone is a muscle relaxant suitable for sprains, strains, and other muscle-based pain.
Compared to the other muscle relaxers, Metaxalone provides a moderately strong relaxing action and produces lesser side effects. Nausea, drowsiness, vomiting, dizziness, and irritability are among the known side effects.
Given the effects, elderly people are at risk of using this drug. Methocarbamol works as a muscle relaxer by blocking pain sensations that reach the brain. Together with physical therapy and rest, it effectively provides pain relief with less sedating effects. While there are fewer incidences of overdose and abuse for methocarbamol compared to other muscle relaxers, significant risks remain.
Common side effects include headaches, drowsiness, dizziness. Meanwhile, serious side effects include liver damage, seizures, anaphylaxis, and confusion. Most muscle relaxers work not by stopping what causes the pain, but by controlling the inhibition and excitation levels of motor neurons in the affected muscles. Muscle relaxers work by mimicking the action of naturally-occurring substances in the body, though exactly how they do so remains a challenge for researchers.
For the elderly, taking muscle relaxers can bring more harm than benefit. Senior citizens already suffer from decreased fitness levels and reduced motor skills on a daily basis. Taking a muscle relaxer could slow them down even more. With muscle relaxer side effects such as drowsiness, dizziness, and confusion, the chances of older patients getting into an accident increase dramatically.
And as these drugs work, people grow accustomed to the lack of pain. A relaxed state can be addictive for people accustomed to pain.
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