Muscles are innervated stimulated to action by nerves from the spinal cord, and cyclobenzaprine dulls the signals sent out by these nerves. By inhibiting these signals, cyclobenzaprine reduces or even eliminates muscle spasms. Other antispasmodic agents include carisoprodol, metaxalone, methocarbamol, orphenadrine, and chlorzoxazone 1. Cyclobenzaprine Flexeril is delivered orally in immediate-release capsules generally 5 - 10 mg or extended-release capsules generally 15 - 30 mg 8.
The evidence suggests that cyclobenzaprine is an effective treatment for musculoskeletal conditions and outperforms placebos, especially in patients with acute lower back or neck pain 1 , 4. Short duration studies show that cyclobenzaprine is also effective in reducing pain from fibromyalgia Cyclobenzaprine has been used in more clinical trials than other antispasmodic drug and consistently relieves pain 4. Use this drug on a short-term basis for acute pain relief.
Long-term usage could mask the underlying cause of the pain 1. Cyclobenzaprine Flexeril is an antispasmodic drug used to treat musculoskeletal pain related to acute injury.
Research supports the use of cyclobenzaprine in patients with acute lower back pain, acute neck pain, and fibromyalgia. The most common adverse effects of cyclobenzaprine are drowsiness, dry mouth, dizziness, and confusion 8. Additional potential side effects of this drug include fatigue, headache, nervousness, dilated pupils, hallucinations, increased heart rate, and digestion issues 1 , 8.
The most common side effects of baclofen are muscle weakness, confusion, vertigo, nausea, and momentary sedation or drowsiness 2 , 4 , Additional potential side effects of this drug include low blood pressure, swelling, shortness of breath, and insomnia among many other reported adverse effects 2. These side effects are most common with oral baclofen and less common with intrathecal baclofen because the drug is injected directly into the fluid surrounding the brain and spinal cord The intrathecal administration of baclofen must be monitored closely by the medical team and patient to ensure the pump is working properly 2.
Any issues with the delivery system can induce withdrawal from the drug in patients who have been using baclofen for more than two months 2. Baclofen withdrawal can be life-threatening with possible multi-organ failure and psychological symptoms 2 , When you want to cease a course of baclofen, you should talk to your doctor to come up with a gradual dose reduction schedule to help avoid withdrawal symptoms associated with discontinuation 2.
Cyclobenzaprine was originally intended for use as an antidepressant 8. Use baclofen cautiously if you have kidney issues 2 , In general, avoid combining baclofen or cyclobenzaprine with any prescription drug that acts on the central nervous system 2 , 8.
Both baclofen and cyclobenzaprine carry significant adverse effects, and you should seek professional medical advice to determine which is best for you.
Be aware of contraindications and drug interactions when taking these medications. Conservative treatment, such as physical therapy, exercise, and NSAIDs, should always be the first choice for remedying muscle spasms and related pain. Most healthcare professionals agree that muscle relaxants are overprescribed, especially since the risks and adverse effects outweigh the benefits in some cases 1.
Always discuss your medical history with your healthcare provider to determine which medication is safest for you to take. Be aware of possible adverse effects and contraindications related to your personal history. Discuss dosing and delivery options with your healthcare provider to minimize risks.
Conservative treatment is the first line of treatment with all muscle spasm. Cyclobenzaprine may help with acute musculoskeletal pain, while baclofen may help relieve chronic pain and spasticity due to a neurological origin. Your medical history will help determine the safest medication for you. Both baclofen and Flexeril cyclobenzaprine are skeletal muscle relaxants that work in different ways to relieve muscle spasm.
Both carry significant adverse effects and should only be used for short-term treatment. Generally, cyclobenzaprine is more effective in treating acute musculoskeletal pain due to an injury in the back or neck. Patients with multiple sclerosis and spinal cord injuries. Common Side Effects. Do not take if pregnant or breastfeeding. Do not use with alcohol or narcotics.
Helprx Flexeril Coupon. Helprx Baclofen Coupon. Flexeril is a muscle relaxant. The way that Flexeril works is that it stops your brain from perceiving pain by blocking the nerve impulses that your brain would interpret as hurtful. Flexeril works best when combined with relaxation and physical therapy, and is used to treat specific injuries and pain, versus a chronic condition like multiple sclerosis.
So if you severely hurt your arm or leg and are experiencing muscle spasms, your doctor may prescribe Flexeril to treat the pain. Flexeril has long lasting effects, relieves pain without impairing muscle function, and is used for short term pain relief from injuries. Flexeril also works well for back pain. Baclofen is both a muscle relaxant and an anti spasmodic medication.
Unlike Flexeril which works for specific injuries, Baclofen works better for chronic conditions like multiple sclerosis, a spinal cord injury, or a spinal cord disease. It is always important to tell your doctor what other medications you are taking so they can be aware of side effects and drug interactions. Baclofen is particularly effective in relieving pain from flexor spasms involuntary muscle spasms from the ankle, knee, or hip , as well as contractions, and muscle rigidity resulting from flexor spasms.
Side Effects For Flexeril and Baclofen. Muscle relaxants like Flexeril and Baclofen can cause side effects that impair the way you think or react to situations. A feeling of being slowed down can be magnified if you take the medication with alcohol or any medication that also has these effects like anti depressants, sleeping pills, narcotic pills, prescription cough medication, other muscle relaxers, anti anxiety medication, or seizure medication.
In some cases, this side effect could be so pronounced that you could die. So, if you are prescribed either Flexeril or Baclofen, try to avoid alcohol and narcotics, and always talk to your doctor about what other medications you may be taking. Contraindicated in patients with arrhythmias, recent myocardial infarction, or congestive heart failure.
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.
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